Adath Hebrew Academy Student Intake Form

* Address

* City

* State

* Zip Code

* Home Phone

* Adult 1 - First Name

* Adult 1 - Last Name

* Adult 1 - Email

* Adult 1 - Cell Phone

* Is there a second adult responsible for the student(s)?

* Adult 2 - First Name

* Adult 2 - Last Name

* Adult 2 - Email

* Adult 2 - Cell Phone

* How many new Students are joining our school?

* Student 1 - First Name

* Student 1 - Last Name

* Student 1 - Birthdate

* Student 1 - Grade as of Sept 2021

* Student 2 - First Name

* Student 2 - Last Name

* Student 2 - Birthdate

* Student 2 - Grade as of Sept 2021

* Student 3 - First Name

* Student 3 - Last Name

* Student 3 - Birthdate

* Student 3 - Grade as of Sept 2021

If you are brand new to A-HA and you were referred by a family who is currently enrolled at Adath Hebrew Academy, please let us know. They will qualify for Adath Dollars to use towards tuition and membership. Brand new families also qualify for Adath Dollars. Please check with our office.

Family Name

Sat, 20 April 2024 12 Nisan 5784