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Religious School Application

Welcome to Congregation B'nai Tzedek's online application for 2017-2018 Religious School year.


Are you a current member of Congregation B'nai Tzedek?(*)


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*** FAMILY / ADULT INFORMATION ***


PARENT 1 / Adult Full Name(*)

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Street Address(*)

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City(*)

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State(*)

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Zip Code(*)

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Preferred E-Mail(*)

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Home Phone (with area code)

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Cell Phone

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Work Phone

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PARENT 2 / Adult Full Name

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Street Address 2

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City 2

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State 2

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Zip Code 2

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Preferred E-mail 2

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Home Phone 2 (with area code)

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Cell Phone 2

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Work Phone 2

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Child/Children live with:(*)




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*** EMERGENCY CONTACT INFORMATION *** This is someone who is NOT Parent 1 or Parent 2.


Contact 1 Full Name(*)

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Contract 1 Relationship(*)

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Home Phone Number 1

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Contact 1 Cell Phone

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Contact 1 Work Phone

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Contact 2 Full Name

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Contact 2 Relationship

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Contact 2 Home Phone

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Contact 2 Cell Phone

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Contact 2 Work Phone

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Consent to use Pictures(*)


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Child 1 English Name(*)

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Child 1 Hebrew Name(*)

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Child 1 Birth Date(*)

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Secular Grade (Sept 2016): Child 1(*)

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Religious School Judaica Grade (Sept 2016): Child 1(*)

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10th Grade CBT Confirmation this year? (*)

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Hebrew School Child 1(*)

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** If you do not have an second child to Register, then please go to the bottom and click NEXT **


Child 2 English Name

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Child 2 Hebrew Name

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Child 2 Birth Date

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Secular Grade (Sept 2016): Child 2

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Reliigous School Judaica Grade (Sept 2016): Child 2

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10th Grade CBT Confirmation this year?

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Hebrew School Child 2

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** If you do not have a third child to Register, then please go to the bottom and click SUBMIT **


Child 3 English Name

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Child 3 Hebrew Name

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Child 3 Birth Date

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Child 3 Secular Grade (Sept 2016)

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Religious School Judaica Grade (Sept 2016): Child 3

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10th Grade CBT Confirmation this year?

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Hebrew School Child 3

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**** BELOW, PLEASE ENTER ANY OTHER INFORMATION YOU WOULD LIKE US TO KNOW ****




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