Jewish Russian Learning Center

Last Name

First Name

Hebrew Name

Address

Phone

Birthday

Grade (Entering)

Allergy Information

Parents Info

Father's Name

Father's Cell Phone

Father's Work Phone

Father's Work Address

Father's Occupation

Father's Email

Mother's Name

Mother's Cell Phone

Mother's Work Phone

Mother's Work Address

Mother's Occupation

Mother's Email

I Hereby permit my child to participate in all school activities, and to join in class and school trips on and beyond school properties and use any transportation selected by the Aleph Hebrew School. *

Referrals

How did you hear about Aleph Hebrew School?

Emergency Contact Information

Person to be contacted in case of an emergency when parents cannot be reached:

Name

Phone

Relationship to the Child

Family Physician

Name

Phone

Medical Release Form

I hereby give consent to the administration of the Aleph Hebrew School to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency. *

Parents Info

Payment Info