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Email *
Last Name of Child #1 *
First Name of Child #1 *
What grade will child #1 be entering in the fall? *
Hebrew Name of Child #1  (If your child does not have a Hebrew Name, please state none.) *
Please list any medical or other information (allergies, etc.) regarding child #1. *
Child #1 Date of Birth *
MM
/
DD
/
YYYY
Do you want to register any additional children? *
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