Tzemach Tzedek School

Call 773-413-9770

Educating the minds and hearts of children to create a world full of the knowledge of Hashem

Tzemach Tzedek School

Educating the minds and hearts of children to create a world full of the knowledge of Hashem

773-413-9770

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Students Registration

Dear Parents of Applicant 'שיחי:

Shalom U’vracha!,

We are pleased that you are interested in joining our School. Please complete & Submit the form below. The on-line form will help to expedite your application.

Total Number of Students Registering *

STUDENT INFORMATION CHILD 1

First Name *

Middle Initial

Last Name *

Gender *

Male

Female

Date of Birth *

Grade *

Please describe any other concerns (social, emotional, scholastic).

Issues

STUDENT INFORMATION CHILD 2

First Name

Middle Initial

Last Name

Gender

Male

Female

Date of Birth

Grade

Please describe any other concerns (social, emotional, scholastic).

Issues

STUDENT INFORMATION CHILD 3

First Name

Middle Initial

Last Name

Gender

Male

Female

Date of Birth

Grade

Please describe any other concerns (social, emotional, scholastic).

Issues

STUDENT INFORMATION CHILD 4

First Name

Middle Initial

Last Name

Gender

Male

Female

Date of Birth

Grade

Please describe any other concerns (social, emotional, scholastic).

Issues

STUDENT INFORMATION CHILD 5

First Name

Middle Initial

Last Name

Gender

Male

Female

Date of Birth

Grade

Please describe any other concerns (social, emotional, scholastic).

Issues

STUDENT INFORMATION CHILD 6

First Name

Middle Initial

Last Name

Gender

Male

Female

Date of Birth

Grade

Please describe any other concerns (social, emotional, scholastic).

Issues

PARENT INFORMATION

Street Address *

City *

State *

Zip Code *

Home Phone *

Were there any conversions or adoptions in the children's family?

Yes No *

Yes

- If yes, please explain

Conversion

FATHER

Title *

First Name *

Last Name *

Hebrew Name *

Phone *

Occupation

MOTHER

Title *

First Name *

Last Name *

Hebrew Name *

Phone *

Occupation

EMERGENCY INFORMATION
Persons to be contacted in case of an emergency when neither parents cannot be reached.

Contact Number

Name *

Phone *

Relationship to Child *

In an emergency, when either parent can't be reached, I authorize the school to call:

Pediatrician *

Phone *

Check *

I hereby GIVE consent to the administration of Tzemach Tzedek School to take whatever medical measures they deem necessary for my child in the event of a medical emergency.

Parent/Legal Guardian Initials *

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Girls' Dress Code