Registration 2022/2023

To register via Mail or Fax Click Here

And the principal of PS*

Childs Full Name*

First NameLast Name

Mothers Jewish Name*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Primary Phone Number*

Area CodePhone Number

Secondary Phone Number

Area CodePhone Number

Mothers E-mail

Fathers E-mail

Childs Birth Date*

MonthDayYear

Gender*

MaleFemale

Grade*

Room Number

PS*

Borough*

To add a second child in the same household, please use the fields below:

Full Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Gender

MaleFemale

PS

Room Number

To add a third child in the same household, please use the fields below:

Full Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Gender

MaleFemale

PS

Room Number

To add a fourth child in the same household, please use the fields below:

Full Name

First NameLast Name

Birth Date

MonthDayYear

Grade

Gender

MaleFemale

PS

Room Number

As the Parent or legal guardian of the above child/ren, I enroll my above child/ren in the Released Time Program, throughout the school year of 2022/23*

Yes

Signature

Name*

Initials*

Date

MonthDayYear

at HourMinutes

Comments

I would like to receive news and updates by email

I allow my child to be photographed or videoed for promotional perposes

Yes

To the National Committee for the Furtherance of Jewish Education

Please enroll my child in the Released Time Program