B”H
Torah Academy
5210 West Esplanade Avenue
Metairie, LA 70006
Phone (504)456-6429 / Fax (504)888-7558 /email: [email protected]
“Rebuilding our New Orleans Jewish community one child at a time”
APPLICATION FOR ADMISSION/REGISTRATION
-Please complete entire form and print clearly.
-Separate forms are required for each child in a family.
-Please notify the school of any changes as soon as possible.
-Proof of immunization, copy of birth certificate, and any records from previous schools (if applicable) must be provided before admission to school.
A) Date when completing form _________________________
B) Student is applying/registering for admission to grade __________ for the academic year ____________
C) If Preschooler or Toddler Group: full day __________ half day __________
Days of week attending ___________________________________________________
D) Who recommended you to apply to Torah Academy?
________________________________________________________________________
E) Family’s Synagogue affiliation, if any ________________________________________
F) STUDENT INFORMATION
Name: (Last)____________________(First) ________________(Middle)_______________
(HEBREW – with correct spelling) _________________________________________
Gender: ________________ [Circle, if applicable] “Kohen” or “Laivi” ?
Home Address: ______________________________________________________________
____________________________________________________________________________
(City) (State) (Zip code)
Home Phone: ( ) _____________________ Date of Birth: _____________________
Jewish Birthdate: ____________________ Place of Birth: (City) ____________________
Child’s Social Security Number: _______________________________________
G) PARENT INFORMATION
Father’s Name:
(Last)_________________________(First)__________________(Hebrew)__________________
Father’s Occupation: _________________________________Work Phone: ________________
Work Address: _______________________________________Cell Phone: ________________
Father’s email: ______________________________________________
Mother’s Name: (Last)_____________________________(First)_________________________
(HEBREW – with correct spelling) ____________________________________
Mother’s Occupation: _____________________________Work Phone: __________________
Work Address: __________________________________ Cell Phone: ____________________
Mother’s email: __________________________________________
Parent Home Address/Phone, If Different Than Child’s: _________ Father _________ Mother
_______________________________________________________________________________
_______________________________________________________________________________
H) STUDENT’S PREVIOUS SCHOOLING – PLEASE PROVIDE ALL NECESSARY DOCUMENTS
School: (Name)_____________________(City)_________________(Grade/s Attended)_______
Attended from: (Month)_________(Year)_________ to (Month)_________ (Year)___________
School: (Name)_____________________(City)_________________(Grade/s Attended)_______
Attended from: (Month)_________(Year)_________ to (Month)__________ (Year)__________
If preschool / first time in school
My child has ______ / has not ______ had interaction with other children socially.
Describe to what extent:
_______________________________________________________________________________
_______________________________________________________________________________
I) FAMILY INFORMATION
Siblings: Name _____________________________ Age _________ School ___________________
Name ________________________________ Age ________ School __________________________
Name ________________________________ Age ________ School __________________________
Name ________________________________ Age ________ School __________________________
Name ________________________________ Age ________ School __________________________
Languages Spoken at home: __________________________________________________________
J) EMERGENCY INFORMATION
Indicate two individuals who may be called in case the parent can not be reached.
#1) Full Name __________________________________ a) Home Phone _____________________
b) Work Phone _______________________________ c) Cell Phone ______________________
#2) Full Name __________________________________ a) Home Phone _____________________
b) Work Phone _______________________________ c) Cell Phone ______________________
|
Authorization for Emergency Medical Care |
In the event I can not be reached to make arrangements for emergency medical care at the time of illness or accident, I hereby authorize the administration of Torah Academy to take my child _____________________________________ to Doctor ________________________________
Address ____________________________________________ Phone ( ) _________________
or to Hospital __________________________________________ or to another licensed physician.
I permit Torah Academy to administer first aid and medication as prescribed to my child. I agree to be responsible for any medical costs incurred. I understand that my child may be dismissed during a school day due to illness, at the discretion of Torah Academy’s administration, as per school illness-policy, and I agree to abide by the administration’s decision.
Signature of Parent or Guardian_____________________________________ Date______________
Medical Information:
-My child _______ may _______ may not be given Tylenol.
-Please indicate if your child is on any doctor-prescribed medication ________________________
-Allergies ___________________________________________________________________________
-Illnesses ___________________________________________________________________________
-Social/Medical Handicaps ____________________________________________________________
K) SCHOOL TRIPS
|
Authorization for School Trip Attendance |
As long as my child is enrolled in Torah Academy, I give permission for him/her to attend
all school trips, provided there is adequate supervision by the faculty or other adult chaperones.
Signature of Parent or Guardian_____________________________________ Date ____________
L) GENERAL INFORMATION
|
Authorization for Photo Publicity |
Torah Academy has my permission to use my child’s photo in its publicity materials.
Signature of Parent or Guardian_____________________________________ Date ____________
Miscellaneous
1) My child can read/write Hebrew ______________ can read/write English _____________
can speak Hebrew __________________ can speak English __________________
is familiar with the daily prayers _________________________________________
2) My child will need remedial help in ______________________________________________
_______________________________________________________________________________
3) Comments about my child: _____________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
4) Goals for my child at Torah Academy : ___________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
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