STUDENT’S ENGLISH NAME:_____________________AGE:______

GRADE FOR YEAR 2007 – 2008:______

STUDENT’S HEBREW NAME:_____________________

FAMILY NAME:________________MOTHER:_____________ FATHER:______________

STUDENT RESIDES WITH: _____MOTHER _____FATHER ______BOTH

STUDENT’S HOME ADDRESS: ____________________________________________

_______________________________________________________________________

EMAIL ADDRESS: ________________________________________________________

HOME TELEPHONE NUMBER: ____________________

WORK TELEPHONE NUMBER: ____________________ MOTHER

CELL TELEPHONE NUMBER: ______________________MOTHER

WORK TELEPHONE NUMBER: ____________________ FATHER

CELL TELEPHONE NUMBER: ______________________FATHER

HEBREW SCHOOL EXPERIENCE: ______ # OF YEARS

HEBREW DAY SCHOOL EXPERIENCE: ____NO ____YES ____ # OF YEARS

MEMBER OF KOL AMI: _____NO ______YES

MOTHER’S ABILITY TO READ HEBREW: _____YES _____NO

FATHER’S ABILITY TO READ HEBREW: _____YES _____NO

SIBLING’S NAME: __________________________ AGE: ____ GRADE: ____

SIBLING’S NAME: __________________________ AGE: ____ GRADE: ____

WOULD YOU LIKE TO MEET WITH THE TEACHER AND/OR EDUCATION DIRECTOR PRIOR TO THE START OF CLASS TO DISCUSS YOUR CHILD? ___ YES __NO

We are a small school and we depend upon and expect parent involvement and support. This includes volunteering in the school and/or participating on the education committee. Please indicate your willingness to volunteer for the following:

__Education Committee __Substitute __Computer Assistance __Phone Tree
__Snack Coordinator __Tutor __Office Aide __Music
__Art __Other___________________________

Do you know a family who might be interested in DRRS? Please write contact information below:
Name________________________ phone or email____________________