Hebrew Tabernacle Hebrew School
Hebrew School Registration 2021/22
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I. STUDENT INFORMATION
Student's Name (and preferred PRONOUN)
Student's Date of Birth
MM
/
DD
/
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Hebrew Class Student is Entering
Student Cell Phone Number
Student's Day School & Grade
Please check all that apply:
 Provide information below about medication, dietary needs, allergies and other information that will help Hebrew Tabernacle Hebrew School best accommodate your child's needs. All information will be kept confidential. Please provide a copy of the students IEP and 504 by bringing or mailing to: Hebrew School, 551 Fort Washington Ave. Nyc NY 10032.
II. PARENT/GUARDIAN INFORMATION
#1 Parent/Guardian Name
Address (w/Apt #)
Email
Cell Phone Number
#2 Parent/Guardian Name
Address (If different from above)
Phone Number
Cell Phone Number
Email Address
Has Your contact information changed from previous years?
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The Hebrew Tabernacle Membership Directory is a wonderful resource for Hebrew School Famlies. May we include your information in this years directory? If so please indicate what information you would like included:
III. DROP OFF and PICK UP
Please list the names of adults IN ADDITION to the Parent(s) or guardian authorized to bring and pick up student.
Name of Authorized Adult for Pick-up & Drop-off
Phone Number of Adult Authorized for Pick-up & Drop-off
2nd Name of Authorized Adult for Pick-up & Drop-off
Phone Number of Authorized Adult for Pick-up & Drop-off
Does this student have permission to SELF-DISMISS at the end of Hebrew School?
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