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Prospective Family Preliminary Application Form

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

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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
CHILD #3
First Name
Last Name
Gender
Birthdate
Grade Entering
Living With
CHILD #4
First Name
Last Name
Gender
Birthdate
Grade Entering
Living With
What languages are spoken in your home?
What characteristics are you looking for in a school?
List any specific needs your child(ren) may have that should be addressed by the school:
With which synagogue(s) are you affiliated?
Which school is your child(ren) currently attending?
Which other schools are you considering at this time?
How did you hear about Harkham Hillel Hebrew Academy?
Would you like to be contacted by a current Hillel family?
If possible, would you like to spend a Shabbat lunch with a current Hillel family?