New Student Enrollment Form

Part A: Information

Student

Name

Full Hebrew name

Birthday

Month

Day

Year

Address

Home Phone

Cell Phone

Current grade:

School currently attending:

Schools attended previously (include years):

Names and ages of siblings:

Father

Name:

Hebrew name:

Address:

Cell phone number:

Occupation

Work Address

Employer

Mother

Name:

Hebrew name:

Address:

Cell phone number:

Occupation

Work Address

Employer

Other

Parent's marital status:

Shul/Synagogue:

Affiliation:

Rabbi's name:

Rabbi's phone number:

Part B: To be filled out by student.

What is your favorite subject and why?

What is your least favorite subject and why?

How have you spent your last two summers?

List some activities you enjoy in your spare time:

Choose one person in your life who has made an impression on you. Why?

What are some of your talents? Describe a way in which you've used them:

List one goal you hope to accomplish this year in school.

Optional: Have we forgotten to ask you something that you'd like to tell us?

BINA