Midrasha Returning Student Enrollment This registration form is for students re-enrolling in Midrasha. If you would like to enroll a new student, please click here. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.RETURNING STUDENT INFORMATION Student Name *FirstLastPlease list the student that is re-enrolling.Confirm Enrollment Information *The information is correct and there are no changes necessaryI need to update the enrollment informationThis refers to the enrollment information we currently have on record. A copy of this information was emailed to you in the first week of August.Signature *Clear SignatureParent/Guardian Email *For confirmation of form submissionUPDATE ENROLLMENT INFORMATION Only complete the fields that you need to update for the current school year. Date of Birth *MM123456789101112DD12345678910111213141516171819202122232425262728293031YYYY20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Student PronounsHe/himShe/herThey/themOtherOther PronounHebrew NameCurrent SchoolCurrent GradeBar/Bat Mitzvah Date (where applicable)Synagogue AffiliationPARENT/GUARDIAN INFORMATION Parent/Guardian #1 *FirstLastParent/Guardian #1 PronounsHe/himShe/herThey/themOtherParent/Guardian #1 Other PronounParent/Guardian #1 Relationship to Student *Parent/Guardian #1 Email *Parent/Guardian #1 Cell Phone *Parent/Guardian #1 Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeParent/Guardian #2 *FirstLastParent/Guardian #2 PronounsHe/himShe/herThey/themOtherParent/Guardian #2 Other PronounParent/Guardian #2 Relationship to Student *Parent/Guardian #2 Email *Parent/Guardian #2 Cell Phone *Parent/Guardian #2 Address *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeSTUDENT INFORMATION Student InfoPlease describe your child's strengths, challenges, and interests.Additional Student InformationPlease let us know any additional information that would help us provide the best possible educational experience for your student (such as an IEP).FAMILY INFORMATION Additional SiblingsPlease list any additional children in the home. Their names, ages and current school.Jewish ExperiencesPlease describe your family's - and child(ren)'s - Jewish involvement and experiences:PHOTO PUBLICATION POLICY Photography Release *I authorize the use of my student's photograph without name identification in school publications and promotional materials without compensation or further authorization.We would like to use photos of our students in newsletters and on the webpage. Students featured in the pictures will not be identified by name without prior permission from the parent. Please check below that you are in agreement with this policy. If you are not in full agreement, please list any restrictions.Photo Publication Policy - Comments/Restrictions:TUITION ASSISTANCE Tuition Assistance InformationPlease check here if you are interested in learning about our tuition assistance program.Limited tuition assistance is available for families who demonstrate a need.Parent/Guardian Signature *Clear SignatureSubmit