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Re-Registration Application

(Please complete all fields for both Parents and at least one child. If you are a single parent household, please complete the information for PArent#1 and type NA in each of the Parent#2 boxes.)

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* Required information.

PARENT/LEGAL GUARDIAN #1
Last Name *
First Name *
Title *
Address *
City, State Zip *
Home Phone *
Cell Phone
Work Phone
Email *
Occupation *
Marital Status *
Synagogue Affiliations *

PARENT/LEGAL GUARDIAN #2*
Last Name *
First Name *
Title *
Address *
City, State Zip *
Home Phone *
Cell Phone
Work Phone
Email *
Occupation *
Marital Status *
Synagogue Affiliations *

*If only one parent, please place NA in each Parent #2 box.
CHILD #1
First Name *
Last Name *
Gender *
Birthdate *
Grade Entering *
Living With *
CHILD #2
First Name
Last Name
Gender
Birthdate
Grade Entering
Living With
New Sibling?
Yes*
*New sibling not guaranteed acceptance.  Confirmation in February 2012.
CHILD #3
First Name
Last Name
Gender
Birthdate
Grade Entering
Living With
New Sibling?
Yes*
*New sibling not guaranteed acceptance.  Confirmation in February 2012.
CHILD #4
First Name
Last Name
Gender
Birthdate
Grade Entering
Living With
New Sibling?
Yes*
*New sibling not guaranteed acceptance.  Confirmation in February 2012.
All families are required to volunteer 15 hours in the school.  Families who wish to opt-out of the volunteer hours may donate $1,200.  Please indicate your selection below.
Volunteer or Give? *
Please note:  Your application is not complete until we have received your registration fees.  If you select Credit Card (below), you will have the opportunity to pay when you submit this form.  

If you select Check or Cash, please send your payment to Harkham Hillel Hebrew Academy, 9120 W. Olympic Blvd., Beverly Hills, CA 90212, Attn: Admissions.

Please make you selection now.
 
Payment Options *