Adath Hebrew Academy Student Intake Form 2024-25

* 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 2023

* Student 2 - First Name

* Student 2 - Last Name

* Student 2 - Birthdate

* Student 2 - Grade as of Sept 2023

* Student 3 - First Name

* Student 3 - Last Name

* Student 3 - Birthdate

* Student 3 - Grade as of Sept 2023

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 receive a $50 refund per student for each new registrant. Brand new families will also receive a $50 refund as a welcome gift. Please check with our office.

Referring Family Name

Wed, 5 February 2025 7 Shevat 5785