Registration - 2024/2025 (Returning Student Only)

Registration Form - 2024/2025
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
Full Name*
Grade Entering*
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

Address (If different from last year's Form)

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

2. Parents Information

Father
Full Name*
Cell*

Phone Number
E-mail*
3. Parents Information

Mother
Full Name*
Cell*

Phone Number
E-mail*
4. Emergency Information
Emergency Contact #1

Full Name
Cell

Phone Number
Relationship
Emergency Contact #2

Full Name
Cell

Phone Number
Relationship
Pediatrician*
Cell*

Phone Number
Insurance*
Policy #*
Emergency Permission*

I give Maimonides/Tamim 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/Tamim 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/Tamim likes to celebrate student work and achievements on our website, social media, newsletters, and other multimedia.

I give Maimonides/Tamim 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.
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 & Book Fee $425.00*

$425
Total

$0.00

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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Registration Form - 2024/2025

1. Student Information

2. Parents Information

3. Parents Information

4. Emergency Information

5. Pick up Authorization

6. Payment