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Application for Registration K-12. Page 1

Please complete the form below. Required fields marked with an asterisk *

Parent Information

Last name, First name*

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Address (For Bus Transportation Purposes)*

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Phone Number *

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Email Address*

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Place of Birth *

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Date entered U.S.

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Synagogue Affiliation

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Marital Status

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How did you hear about Be'er Hagolah?

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What would you like your child to gain at Be'er Hagolah?

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Student Information

Last name, First name*

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Date of Birth *

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Place of Birth

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Address*

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Grade Entering*

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Name of Previous School(s) and Grades Attended*

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What subjects and hobbies do you enjoy?

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