Application for Registration 5784 (2023-2024)

Registration:

Tuition for 5784 for an out of town student: $17,500. Tuition for 5784 for an in-town student: $14,000. Applicant will not be considered until receipt of $200 registration fee.

Step 1 of 3

Student Information
Hebrew first and last name*

Please type in Hebrew (online hebrew keyboard)
Name*
Legal First Name Nick Name Last Name
Date of birth*
Hebrew Date of birth*
Address*
Street Address City State / Province / Region ZIP / Postal Code Country

Fathers Information
Name*
Fathers full Hebrew name Fathers full legal name
(online hebrew keyboard)
Email*

May be same as spouses
Cell Phone*
Home Phone*
Work Phone*
Occupation*
Mothers Information
Name*
Mothers full Hebrew name Mothers full legal name
Email*

May be same as spouses
Cell Phone*
Home Phone*
Work Phone*
Occupation*
Parent's Rav/Mashpia*
Phone*

Student Profile
Schools Attended
Please list the schools your son has attended in the last two years:
2022/23 School Attended*
2022/23 Grade*
2022/23 Primary Teacher*
Teacher's Phone*
2022/23 Principal*
Phone*
2021/22 School Attended*
2021/22 Grade*
2021/22 Primary Teacher*
2021/22 Principal*
Phone*
Summer Programs
Please list the summer programs your son has attended in the past year:
2022 Summer Program*
Name of Director*
Phone*
Name of Learning Teacher*
Name of Counselor*
Please describe any other information about your son (e.g. social, emotional, scholastic, etc., or any other issues/information you feel may be pertinent):

Application for Registration 5784 (2023-2024)

Registration:

Step 1 of 3

Student Information

Fathers Information

Mothers Information

Student Profile

Schools Attended

Summer Programs