Application for Registration K-12

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

Student's Last Name*

Answer required for "Student's Last Name"

Student's First name*

Answer required for "Student's First name"

Student's Legal Name*

Answer required for "Student's Legal Name"

Student's Hebrew Name

Answer required for "Student's Hebrew Name"

Address

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

Mobile Phone*

Number Required

Social Security #

Answer required for "Social Security #"

Student's Date of Birth*

Answer required for "Student's Date of Birth"

Date Entered U.S.A.

Answer required for "Date Entered U.S.A."

PREVIOUS EDUCATION:

NAME OF SCHOOL - GRADE - CITY

Answer required for "NAME OF SCHOOL - GRADE - CITY"

NAME OF SCHOOL - GRADE - CITY

Answer required for "NAME OF SCHOOL - GRADE - CITY"

Has your child ever attended Be'er Hagolah?

Answer required for "Has your child ever attended Be'er Hagolah?"

If Yes, which year? What Grade?

Answer required for "If Yes, which year? What Grade?"

LIST THE NAMES OF ALL MEMBERS IN THE HOUSEHOLD (ADULTS&CHILDREN):

Name

Answer required for "Name"

Date of birth

Answer required for "Date of birth"

School

Answer required for "School"

Grade

Answer required for "Grade"

Name

Answer required for "Name"

Date of birth

Answer required for "Date of birth"

School

Answer required for "School"

Grade

Answer required for "Grade"

Name

Answer required for "Name"

Date of birth

Answer required for "Date of birth"

School

Answer required for "School"

Grade

Answer required for "Grade"

Name

Answer required for "Name"

Date of birth

Answer required for "Date of birth"

School

Answer required for "School"

Grade

Answer required for "Grade"

Name

Answer required for "Name"

Date of birth

Answer required for "Date of birth"

School

Answer required for "School"

Grade

Answer required for "Grade"

Name

Answer required for "Name"

Date of birth

Answer required for "Date of birth"

School

Answer required for "School"

Grade

Answer required for "Grade"

Name

Answer required for "Name"

Date of birth

Answer required for "Date of birth"

School

Answer required for "School"

Grade

Answer required for "Grade"

UPLOAD STUDENT'S PHOTOGRAPH HERE

Answer required for "UPLOAD STUDENT'S PHOTOGRAPH HERE"

Choose a file or drag it here.

THIS FORM MUST BE COMPLETED FOR SCHOLARSHIP.

ALL INFORMATION PROVIDED WILL BE CONSIDERED CONFIDENTIAL.

FATHER

Are you employed?

Answer required for "Are you employed?"

Yes

Employer

Answer required for "Employer"

Work #

Number Required

Position

Answer required for "Position"

How long

Answer required for "How long"

Monthly gross income

Answer required for "Monthly gross income"

Other income

Answer required for "Other income"

MOTHER

Are you employed

Answer required for "Are you employed"

Yes

Employer

Answer required for "Employer"

Work #

Number Required

Position

Answer required for "Position"

How long

Answer required for "How long"

Monthly gross income

Answer required for "Monthly gross income"

Other income

Answer required for "Other income"

Do you receive any assistance?

Answer required for "Do you receive any assistance?"

Welfare

Food stamps

SSI

Pension

Child support

Would you be interested in applying for vouchers

Answer required for "Would you be interested in applying for vouchers"

Yes

Do you rent or own your apartment?

Answer required for "Do you rent or own your apartment?"

Rent

Own

How much is your monthly rent or mortgage

Answer required for "How much is your monthly rent or mortgage"

Do you own your car

Answer required for "Do you own your car"

Yes

If YES, what is the make and year?

Answer required for "If YES, what is the make and year?"

Additional Notes:

Answer required for "Additional Notes:"

Parent's Signature

Answer required for "Parent's Signature"

Registrar's Signature

Answer required for "Registrar's Signature"

Date:

Answer required for "Date:"

PARENTS' INFORMATION

FATHER'S

First Name*

Answer required for "First Name"

Last Name*

Answer required for "Last Name"

Hebrew Name

Answer required for "Hebrew Name"

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

CELL PHONE #*

Number Required

E-Mail

Answer required for "E-Mail"

Date of Birth*

Answer required for "Date of Birth"

Place of Birth*

Answer required for "Place of Birth"

Date Entered U.S.A.

Answer required for "Date Entered U.S.A."

From which country*

Answer required for "From which country"

Do you have an Israeli citizenship*

Answer required for "Do you have an Israeli citizenship"

Yes

MOTHER'S

First Name*

Answer required for "First Name"

Last Name*

Answer required for "Last Name"

Hebrew Name

Answer required for "Hebrew Name"

Mother's maiden name (before marriage)*

Answer required for "Mother's maiden name (before marriage)"

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal

Answer required for "Zip/Postal"

CELL PHONE #*

Number Required

E-MAIL

Answer required for "E-MAIL"

Home Phone #

Number Required

Date of birth*

Answer required for "Date of birth"

Place of birth

Answer required for "Place of birth"

Date entered U.S.A.

Answer required for "Date entered U.S.A."

From which country*

Answer required for "From which country"

Do you have an Israeli citizenship*

Answer required for "Do you have an Israeli citizenship"

Yes

PARENT'S SYNAGOGUE

Answer required for "PARENT'S SYNAGOGUE"

Family's Rabbi

Answer required for "Family's Rabbi"

Rabbi's Phone #

Number Required

Marital Status

Answer required for "Marital Status"

Married

Divorced

Widowed

Separated

If parents are separated or divorced, who is the legal guardian

Answer required for "If parents are separated or divorced, who is the legal guardian"

Mother

Father

Father remarried

Answer required for "Father remarried"

Yes

Mother remarried

Answer required for "Mother remarried"

Yes

Any relevant documents pertaining or responsibility for school tuition should be made available to the school

Paternal grandparents (Father's Parents):

Answer required for "Paternal grandparents (Father's Parents):"

Place of residence

Answer required for "Place of residence"

Maternal grandparents (Mother's Parents):

Answer required for "Maternal grandparents (Mother's Parents):"

Place of residence

Answer required for "Place of residence"

GENERAL INFORMATION

HOW DID YOU HEAR ABOUT BE'ER HAGOLAH?

Answer required for "HOW DID YOU HEAR ABOUT BE'ER HAGOLAH?"

WHAT WOULD YOU LIKE YOUR CHILD TO GAIN AT BE'ER HAGOLAH INSTITUTES?

Answer required for "WHAT WOULD YOU LIKE YOUR CHILD TO GAIN AT BE'ER HAGOLAH INSTITUTES?"

WHAT SUBJECTS DOES YOUR CHILD ENJOY MOST?

Answer required for "WHAT SUBJECTS DOES YOUR CHILD ENJOY MOST?"

WHAT ARE SOME HOBBIES YOUR CHILD ENJOYS MOST?

Answer required for "WHAT ARE SOME HOBBIES YOUR CHILD ENJOYS MOST?"

Please fix the highlighted areas below before submitting.

Application for Registration K-12