Registration - 2022/2023

Registration Form - 2022/2023
Maimonides Jewish Day School is an accredited, kindergarten through 8th-grade school committed to teaching the whole child, inspiring lifelong learning, and providing personalized, meaningful, and empowering Judaic and General Studies education for a diverse community of Jewish children.
1. Student Information
Name*
First NameLast Name
Hebrew Name
Birth Date*
MonthDayYear
Hebrew Birthday
Previous School Attended*
Name & Number
Grade Entering*
Is The Applicant Adopted?*
YesNo
Was The Applicant Converted?*
YesNo
Food and/or Drug Allergies:
Is This Child Currently Taking Prescribed Medication?*
YesNo
If Yes, Please List The Medications & The Reason For Taking
Are There Any Problems That Restrict This Child's Activities?*
YesNo
If Yes, Please Explain
Primary Language Spoken At Home*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Synagogue Affiliation
2. Parents Information
Father
Name*
First NameLast Name
Hebrew Name
Cell*
Area CodePhone Number
E-mail*

Address (if different from above)

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Best Method Of Contact*
Employer*
Name & Phone Number
3. Parents Information
Mother
Name*
First NameLast Name
Hebrew Name
Cell*
Area CodePhone Number
E-mail*

Address (If different from above)

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Employer*
Name and Phone Number
Best Method Of Contact*
4. Emergency Information
Emergency Contact #1*
First NameLast Name
Phone Number*
Area CodePhone Number
Relationship*
Emergency Contact #2*
First NameLast Name
Phone Number*
Area CodePhone Number
Relationship*
Pediatrician*
Phone Number*
Area CodePhone Number
Insurance*
Policy #*
Emergency Permission*
I give Maimonides Jewish Day School permission to administer medical care to my child in the case of emergency, G-d forbid. In the event that we are unable to reach either emergency contact, Maimonides will act in the best interest of the child, to seek appropriate medical attention as needed.I will provide a copy of current immunization status
Photo - Maimonides likes to celebrate student work and achievements on our website, social media, newsletters, and other multimedia.
I give Maimonides Jewish Day School permission to photograph and videotape my children and use the photos and videos (without their names) for our website, social media, newsletters, and other multimedia as necessary.
School Directory - The Maimonides Family Directory is distributed to Maimonides families to support connections within the community. It is exclusively for noncommercial use. Please indicate below your inclusion preferences.*
YES you may include our family in The Maimonides Jewish Day School Family Directory.No, I do not want to include our family in The Maimonides Jewish Day School Family Directory
Field Trips*
I give my child permission to attend all field trips.I would be willing to carpoolI do not give my child permission to attend field trips
5. Pick up Authorization
The person picking up your child will be required to present his/her photo ID. Under no circumstances will a child be released to a person who has NOT been authorized by the parent. This is for the protection and safety of your child.
Please list all authorized persons:*
6. Payment
Registration Fee $250.00 per child. Early Registration prior to March 28th - $125*
$250$125
Total
$0.00

Payment*

Credit Card Paypal Other

Postal / Zip Code

Country

Should be Empty:

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Registration Form - 2022/2023

1. Student Information

2. Parents Information

3. Parents Information

4. Emergency Information

5. Pick up Authorization

6. Payment