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New Student Application 2020-2021
Applicant Primary Information
First Name
*
Middle Name
*
Last Name
*
Gender
*
Male
Female
Hebrew Name
*
Date of birth
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Hebrew Date of Birth
*
Profile Picture
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Please upload image file.
Please attach a copy of your child's birth certificate
*
Address
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City
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State
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Zipcode
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Country
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Home Phone
*
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Current school Information
Current School
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Current Grade
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In what grade did your child start attending this current school?
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Contact Name at school
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Contact Number
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Contact Email
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I grant Arevim Schoolhouse permission to contact my child's current school and if applicable to receive student records, attendance records, health records, standardized achievement.
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Yes
No
Parent Initials
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Please attach your child's report cards from last and current year for your child entering Grades 1 and up.
*
Additional Report Card
*
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Father's Information
Full Name
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Deceased?
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Yes
No
Hebrew Name
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Home Address, if different from student
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Cell phone
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Email
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Occupation
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Employer
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Work Address
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Work Phone
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Were you born Jewish?
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Yes
No
Did you Convert?
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Yes
No
If Yes, date and Rabbi of conversion
*
Please attach conversion document
*
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Mother's Information
Mother's full name
*
Deceased?
*
Yes
No
Hebrew Name
*
Home Address, if different than student
*
Cellphone
*
Email
*
Occupation
*
Employer
*
Work Address
*
Work Phone
*
Were you born Jewish?
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Yes
No
Did you Convert?
*
Yes
No
If Yes, date and Rabbi of conversion
*
Please attach conversion document
*
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Additional Information about your child
Does your child have any learning, social, physical, medical or other special needs? If yes, please explain.
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Does your child currently have an IEP or receive support services (in or out of school)?
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Yes
No
If yes, what services is he/she currently receiving? For how long has your child received these services? Example: OT, PT, Speech, Counseling, Special Educational Services, Private Reading Tutoring
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Please attach any standardized tests or evaluations completed for your child
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Is there anything else we should know about your child?
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Medical Information
Insurance Name
*
Insurance ID
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Name of Insured person
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Providor phone number
*
Physician Name
*
Physician Number
*
Does your child have any food allergies?
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Yes
No
If yes. please specify
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Does your child have any allergies to medication?
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Yes
No
If yes, please specify
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Has your child ever required treatment with an EpiPen?
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Yes
No
If Yes, does he/she carry his/her EpiPen?
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Yes
No
Does your child have Asthma?
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Yes
No
Does your child have an ongoing medical problem?
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Yes
No
If yes, please explain.
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Has had major surgery?
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Yes
No
If yes, please explain.
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Has had an Athletic Injury?
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Yes
No
If yes, please explain.
*
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Emergency Contact 1
Contact Name
*
Contact Phone Number
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Relationship to child
*
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Emergency Contact 2
Contact Name 2
*
Contact Phone Number 2
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Relationship to Child 2
*
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Carpool Information
People allowed to pick up your child
*
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Siblings Information
Sibling 1 Name
*
Date of birth 1
*
Gender 1
*
Male
Female
Please list the name of current school attending 1
*
Sibling 2 Name
*
Date of Birth 2
*
Gender 2
*
Male
Female
Please list the name of current school attending 2
*
List any additional siblings here with gender and school attending
*
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Paternal Grandparents Information
Grandmother's Name
*
Grandmother's Home Address
*
Grandmother's Email
*
Grandfather's Name
*
Grandfather's Home Address, if different.
*
Grandfather's email
*
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Maternal Grandparents Information
Grandmother's Name
*
Grandmother's Home Address
*
Grandmother's Email
*
Grandfather's Name
*
Grandfather's Home Address, If different.
*
Grandfather's Email
*
Fees
Mandatory Fees
Application Fee 2020-2021
250
Total
250.00
Please click
here
for our 2019-2020 tuition schedule.
Please accept the terms & conditions to submit this form.
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