School Registration

REGISTRATION FOR SCHOOL

2011/2012

Family Name:

Parent/Guardian Name(s):

Street Address:*

City and Zip Code:*

Phone:
(h)
(o)
(c)

Email Address:*

If applicable, additional:

Parent/Guardian Name(s):

Street Address:

City and Zip Code:

Phone:
(h)
(o)
(c)

Email Address:

Student #1

First and Last Name:*

Hebrew Name:

Birth Date:*

Current School:

Current School Phone:

Entering Grade*:
Special Talent:

Student #2

First and Last Name:

Hebrew Name:

Birth Date:

Current School:

Current School Phone:

Entering Grade:
Special Talent:

Student #3

First and Last Name:

Hebrew Name:

Birth Date:

Current School:

Current School Phone:

Entering Grade:
Special Talent:

Please provide further information about your child(ren) of which his/her teacher should be aware, including, but not limited to, special family situation, diagnosed learning disabilities, or education plan.

DO YOU ALLOW YOUR CHILD(REN) TO BE GIVEN:
Adult Strength Tylenol/Advil*:
Children’s Strength Tylenol/Advil*:

We Accept Visa and MasterCard

Contact the Temple Sinai Office
Would you prefer to make a payment by phone?

508 755-2519

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