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 to Student

Relationship 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

Grade

Hebrew Name

* Date of Birth

MM/DD/YYYY

Date of Birth

MM/DD/YYYY

* Public School

Public School

Child's Doctor

Name and phone number

Child's Doctor

Allergies or Medical Conditions

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

If no more children skip to SUBMIT button

Student #3 First Name

Student #3 Last Name

* Grade

Grade

Hebrew Name

* Date of Birth

MM/DD/YYYY

Date of Birth

MM/DD/YYYY

Public School

Child's Doctor

Name and Phone Number

Child's Doctor

Allergies or Medical Conditions

Allergies or any Medical Condition

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

Tue, July 23 2019 20 Tammuz 5779

Congregation Brothers of Israel

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