How many children are you registering today?*Please enter a number from 1 to 3.Enter number from 1 to 3.Child 1 Name* First Last Hebrew Name DOB* MM slash DD slash YYYY Age*Gender* Boy Girl School* Grade Entering*Pre-SchoolKindergartenFirstSecondThirdFourthFifthSixthSeventhAlef Bet Hebrew School 2025*Product Name*Second ChildChild 2 Name* First Last Hebrew Name DOB* MM slash DD slash YYYY Age*Gender* Boy Girl School* Grade Entering*Pre-SchoolKindergartenFirstSecondThirdFourthFifthSixthSeventhProduct Name*Product Name*Third ChildChild 3 Name* First Last Hebrew Name DOB* MM slash DD slash YYYY Age*Gender* Boy Girl School* Grade Entering*Pre-SchoolKindergartenFirstSecondThirdFourthFifthSixthSeventhProduct Name*Product Name*Previous Jewish Education?* Yes No Where? Is the natural mother of the Child(ren) Jewish?* Yes No Were there any conversions or adoptions in the Family?* Yes No Please provide details:Are the child(ren)s parents living together?* Yes No Parent InformationFather's Name* First Last Hebrew Name Home PhoneFather's Cell*Father's Email* Occupation* Mother's Name* First Last Hebrew Name Home PhoneMother's Cell*Mother's Email* Occupation* Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Person to be contacted in case of an emergency when parents cannot be reached.Name* First Last Phone*Relationship to child* Does your child attend any special education program in public school?* Yes No Please explain*CONFIDENTIAL: Does your child have any allergies or other medical condition, require medication, or any special abilities or disabilities we should be aware of?* Yes No Please describe them and indicate special precautions or care needed.As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Alef Bet Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Alef Bet Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Alef Bet Hebrew School activities and that these pictures may be used for marketing purposes.* I Accept Name* Initials*
