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ב"ה

Education Shorashim Roots

Registration

Required for enrollment

SHORASHIM ROOTS
First day of school - Sunday, October 11, 2026
1. STUDENT INFORMATION
Student's Name*
First Name Hebrew Name Last Name
Birth Date*

Month Day Year
Age*
What age will be the student's be in September 2024?
Gender*

MaleFemale
T-Shirt size*
Does your child speak/understand Hebrew?*

NoneWellSomewhat
Does your child have a previous Jewish education*

YesNoSomewhat
If yes, please describe*
Grade?*
What will be the grade the student will be entering this school year?
What else would you like us to know about your child?
Have there been any conversions or adoptions in the family? If yes, please explain.
Does your child have any allergies?*
2. PARENT INFORMATION
Mother*
First Name Last Name
Phone Number*

Area Code Phone Number
E-mail*

Address*

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

Father*
First Name Last Name
Phone Number*

Area Code Phone Number
E-mail*

Address (if different)

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

Marital Status*

MarriedDivorcedSeparatedSpouse is deceased
Mother born Jewish?*

YesNoConverted (See note below)
NOTE: We accept conversions recognized by the rabbinical courts in Israel (Rabanut of Israel).
Converted by whom?
3. EMERGENCY INFORMATION
Emergency Contact*
First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
Should be Empty:

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