Sinai Temple
Douglas Family Early Childhood Center
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Admission Inquiry Form

Student Information
First Name*
     
Middle Initial
     
Last Name*
     
Nickname
     
Gender*
   
Date of Birth (mm/dd/yyyy)*
     
Name of current school*
       
Current grade level*
     
Applying for grade*
   
Applying for school year*
     

Parent Information
First Parent's relationship to student*
   
First Parent's first name*
     
First Parent's last name*
     
Second Parent's relationship to student*
   
Second Parent's first name*
     
Second Parent's last name*
     
Address Line 1*
     
Address Line 2
     
City*
     
State*
   
Zip Code*
     
Country*
     
Phone number*
       
Fax number
     
Work/Cell phone number*
       
Email Address*
     

Other Information
Sibling is also Inquiring or Applying to School
   
Financial Aid Requested
   
My child has attended Hebrew Language classes
   
Sinai Temple Member
   
Siblings at Sinai Akiba Academy
   
Attends the Douglas Family Early Childhood Center
   
Sibling is also Inquiring or Applying to the Douglas Family Early Childhood Center
   
How did you hear about Sinai Akiba Academy?
   
If you chose other, please specify here
       
Please provide any other information
       
If you would like a copy of this submission, please put your email address in the field below.

Please Note: Questions marked with an asterisk (*) are required.
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