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Getting to Know You
Child's First Name
*
Child's Last Name
*
Child's Age
*
Child's Date of Birth
*
Month
Day
Year
Child's Gender
*
Female
Male
Is Child Adopted?
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Yes
No
If you answered Yes to above (Is Child Adopted?), please explain further
Which of the following family members are Jewish? Please check all that apply.
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Mother
Father
Maternal Grandmother
Maternal Grandfather
Has anyone in your family converted to the Jewish faith?
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Yes
No
If you answered yes above, which Beit Din and Rabbi did the conversion (if this doesn't apply to you, please add N/A to your response)?
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We'd love to learn about your child! Please share some of his/her unique strengths, interests and personality
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Past Education (please list name of schools, addresses, phone numbers, grade level completed, dates and two references per school)
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Do you notice any signs of developmental delay?
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Yes
No
If you answered yes above, please explain further
Has your child ever been dismissed from a school?
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Yes
No
If you answered yes above, please explain further
Parent/Guardian 1 First Name
*
Parent/Guardian 1 Last Name
*
Parent/Guardian 1 Email
*
Parent/Guardian 1 Phone
*
Parent/Guardian 2 First Name
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Parent/Guardian 2 Last Name
*
Parent/Guardian 2 Email
*
Parent/Guardian 2 Phone
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Address
*
Synagogue Affiliation
How did you hear about us?
*
What interests you about our school/programs?
*
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