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Bais Rivkah Home Registration 5785
Only complete this form AFTER receiving an acceptance email. This form is for new students only.
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* Indicates required question
Email
*
Your email
Student's Full First Name:
*
Your answer
Name used by Student:
*
If different from full name
Your answer
Students Last Name:
*
Your answer
Grade Entering Sept 2024
*
Your answer
Date of Birth- Jewish
*
Your answer
Date of Birth- Secular
*
MM
/
DD
/
YYYY
Full Home address
*
Your answer
Home Phone
*
Your answer
Father's Name
*
Your answer
Father's Cell Number
*
Your answer
Father's Email
*
Your answer
Mother's Name
*
Your answer
Mother's Cell Number
*
Your answer
Mother's Email
*
Your answer
Student's Cell Number
*
Your answer
Student's Email
*
Your answer
Has your daughter completed her registration for Bais Rivkah High School?
*This is mandatory in order to register for the dorm.
Yes
No
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Please describe your daughter's personality in a few short sentences.
*
Your answer
Does your daughter have any emotional issues that we can support her with?
Your answer
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