CBOI Rabbi Howard Hersch Religious School Registration (RETURNING)

Registration 2019-2020
Welcome to our new online school registration form.
This form allows you to register your child(ren) on line
for the Rabbi Howard Hersch Religious School.

Please verify and fill in any missing pieces of information
Press the SUBMIT button at the end of the Registration Form

FAMILY INFORMATION

* Parent #1 Last Name

Parent #2 Last Name

* Parent #1 First Name

Parent #2 First Name

* Relationship (#1) to Student

Relationship (#2) to Student

Parent #1 Home Phone

Parent #2 Home Phone

Parent #1 Work Phone

Parent #2 Work Phone

* Parent #1 Cell Phone

Parent #2 Cell Number

Parent #1 Email

Parent #2 Email

* Parent #1 Home Address

Parent #2 Home Address

Parent #1 City

Parent #2 City

Parent #1 State

Parent #2 State

Parent #1 Zip

Parent #2 Zip

* May we take & use your child(ren)'s photo?

YES, for any useNO, not for any use

* Emergency Contact Information

Please provide the name and number of a local friend or family member
who can be contacted in the case of emergency (if both parents are unreachable).

STUDENT INFORMATION

* Student #1 First Name

Student #2 First Name

* Student #1 Last Name

Student #2 Last Name

* Grade (student 1)

Grade (student 2)

Hebrew Name (student 1)

Hebrew Name (student 2)

* Date of Birth (student 1)

MM/DD/YYYY

Date of Birth (student 2)

MM/DD/YYYY

* Public School (student 1)

Public School (student 2)

Child's Doctor (student 1)

Name and phone number

Child's Doctor (student 2)

Allergies or Medical Conditions (student 1)

Allergies or Medical Conditions (student 2)

Please provide any additional information about your child regarding learning, social, or behavior issues that will help us offer the best possible school experience: (student 1)

Please provide any additional information about your child regarding learning, social, or behavior issues that will help us offer the best possible school experience: (student 2)

If no more children skip to SUBMIT button

Student #3 First Name

Student #4 First Name

Student #3 Last Name

Student #4 Last Name

* Grade (student 3)

Grade (student 4)

Hebrew Name (student 3)

Hebrew Name (student 4)

* Date of Birth (student 3)

MM/DD/YYYY

Date of Birth (student 4)

MM/DD/YYYY

Public School (student 3)

Public School (student 4)

Child's Doctor (student 3)

Name and Phone Number

Child's Doctor (student 4)

Allergies or Medical Conditions (student 3)

Allergies or any Medical Condition (student 4)

Please provide any additional information about your child regarding learning, social, or behavior issues that will help us offer the best possible school experience: (student 3)

Please provide any additional information about your child regarding learning, social, or behavior issues that will help us offer the best possible school experience: (student 4)

Sun, February 23 2020 28 Shevat 5780

Congregation Brothers of Israel

L'dor Vador—From Generation to Generation since 1883
לדור ודור