Prospective Parent Form – Spivak Hebrew Academy

Spivak Hebrew Academy

Spivak Hebrew Academy offers a rich and inspiring learning environment where children develop their minds and bodies in a safe and nurturing setting.

About
- School Philosophy
- Administration
Early Childhood
Elementary
Middle
- Meet Our Staff
- Academics
Admissions
- Enrollment
- Tuition Schedule and Fees
School Life
Contact
- Donate

About
- School Philosophy
- Administration
Early Childhood
Elementary
Middle
- Meet Our Staff
- Academics
Admissions
- Enrollment
- Tuition Schedule and Fees
School Life
Contact
- Donate

Prospective Parent Intake Form

Parent Registering

Name(Required)

First Last

Email(Required)

Phone

First Child

Last Name (First Child)

First Name (First Child)

Middle Name (First Child)

Gender (First Child)

Date of Birth (First Child)(Required)

MM slash DD slash YYYY

Second Child

Last Name (Second Child)

First Name (Second Child)

Middle Name (Second Child)

Gender (Second Child)

Date of Birth (Second Child)

MM slash DD slash YYYY

Family Info

Address

Street Address City State / Province / Region ZIP / Postal Code

Mother's Name

First Last

Mother's Cell

Mother's Email

Mother's Occupation

Father's Name

First Last

Father's Cell

Father's Email

Father's Occupation

Background Info

Is your child up to date on Immunizations?

Yes

No

Does your child have any special accommodations

Yes

No

(ex. IEP, Social/Behavioral Challenges, Educational Modification)

If Yes, we require review of any psychological testing or Child Study Team information, including but not limited to: 1. Educational Evaluation 2. Psychological Assessment 3. IEP

Is Biological Mother Jewish by Birth

Yes

No

Did you (mother) have an Orthodox Conversion

Yes

No

Name of Conversion Rabbi

Is Biological Father Jewish by Birth

Yes

No

Did you (father) have an Orthodox Conversion

Yes

No

Name of Conversion Rabbi

How did you hear about our school?

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