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Religious School Intake Form
Please verify reCaptcha before submitting the form.
THIS FORM IS FOR NEW FAMILIES ONLY.
If you are a current member of B'nai Tikvah, do not submit this form.
Instead, login into your ShulCloud account
here
and click on the Start School Enrollment button to register your child(ren).
How many children are you registering for Religious School?
Please Select One
One child
Two children
Three children
Child 1 - First Name
Child 1 - Last Name
Child 1 - Date of Birth
Child 1 - Grade Entering September 2022
Child 2 - First Name
Child 2 - Last Name
Child 2 - Date of Birth
Child 2 - Grade Entering September 2022
Child 3 - First Name
Child 3 - Last Name
Child 3 - Date of Birth
Child 3 - Grade Entering September 2022
Adult 1 - First Name
Adult 1 - Last Name
Adult 1 - Email
Adult 1 - Mobile Phone
Adult 1 - Address
Adult 1 - City
Adult 1 - State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Adult 1 - Zip Code
Is there a second Parent/Guardian?
Please Select One
Yes
No
Adult 2 - First Name
Adult 2 - Last Name
Adult 2 - Email
Adult 2 - Mobile Phone
Does the second Parent/Guardian live at the same address?
Please Select One
Yes
No
Adult 2 - Address
Adult 2 - City
Adult 2 - State
Adult 2 - Zip Code
Sun, December 22 2024 21 Kislev 5785