HEBREW ACADEMY OF TAMPA –  Online ENROLLMENT FORM

CLICK HEREto Download a PDF Enrollment Form to bring into Hebrew Academy Office

CLICK HERE for the 2014-2015 Fee Schedule

 

Please provide the following information about your CHILD.
 
Child's name     Date of birth

First Name
Last Name
Hebrew Name
DD/MM/YYYY
       
Address      

Street Address
City


Postal / Zip Code
       
 Phone Number      

Cell Phone		  
Home Phone		    

 

Describe any Illnesses, diseases, disabilities, or allergies, if applicable, that may affect your child’s general health, school, work, or athletics program participation (or write “N/A")
 
 
 Pediatrician Name:  Pediatrician Phone:
 

What are your child’s most pronounced interests? 
 
 

 Please provide the following information about your child’s previous school & education history:
 
Previous School Name School Phone
 Address  

Street Address
City


Postal / Zip Code

 
Hebrew Language Education & Level (Describe):

 
 

 

Please provide the following information about your family:
 For Father
     
       
 Name      

First Name
Last Name		    
       
Email

Occupation

   
       
 Home Address      

Street Address
City


Postal / Zip Code
       
 Work Address      

Street Address
City


Postal / Zip Code
       
       

Please provide the following information about your family:
 For Mother
     
       
 Name      

First Name
Last Name		    
       
Email

Occupation

   
       
 Home Address      

Street Address
City


Postal / Zip Code
       
 Work Address      

Street Address
City


Postal / Zip Code
       
       

 

 

 Other Emergency Contact #1
       
Name      

First Name
Last Name		    
       
Relation to child      
     
       
Phone Numbers      

Cell Phone
Daytime Phone
Other Phone		  
       
  Other Emergency Contact #2
       

First Name
Last Name		    
       
Relation to child      
     
       
Phone Numbers      

Cell Phone
Daytime Phone
Other Phone		  
       
 Other children living with the enrolling student
       
Name Age  Name  Age

 

Terms of Agreement

If an emergency arises and none of the above emergency contacts can be reached in a timely manner, I hereby give the Hebrew Academy staff permission to take whatever measures it deems appropriate for the situation.

I/we hereby give permission for my/our child to participate in all school activities, join in class and school field trips on and beyond school property, and for my/our child to be recorded on photograph & video while participating in Hebrew Academy activities, and for such photographs & videos to be used in Hebrew Academy materials & resources of any type.
   
 Parent/Gaurdian Name

 Date

Full Name
DD/MM/YYYY
   
 Parent/Gaurdian Name

 Date

Full Name

DD/MM/YYYY
   


At the Hebrew Academy, we have a sincere interest in meeting the needs of every child. Upon receiving your completed enrollment form, an interview for you and your child will be arranged at your convenience.

Your child will not be admitted to school without an HRS medical form. Please return your HRS medical form (Florida School Physical) along with this completed enrollment form to our below address, or fax to: (813) 265-8543. Thank you for your interest in Hebrew Academy of Tampa. We look forward to partnering with you for this next exciting step in your child’s academic development!

Sincerely,

Mrs. Sulha Dubrowski, Founder & Director