Torah Academy of Buffalo Grove Hebrew School

720 Armstrong Drive

Buffalo Grove IL 60089

APPLICATION FOR ADMISSION

HOW DID YOU HEAR ABOUT OUR SCHOOL?

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STUDENT INFORMATION: (PLEASE PRINT)

NAME:_______________________________________________________________________________

(LAST) (FIRST) (FULLMIDDLE) HEBREW NAME)

DATE OF BIRTH:_________________ AGE:______________ GENDER: (CIRCLE ONE) M F

APPLYING FOR: Torah Academy Sunday School Entering Grade: K 1 2 3 4 5 6 7 8

PRESENT SCHOOL:_________________________________________________ GRADE LEVEL:_________

OTHER SCHOOLS PREVIOUSLY ATTENDED:___________________________________________________

CHECK if
applicable: ____FATHER DECEASED ____PARENTS SEPARATED ____ADOPTED (CHILD AWARE)

____MOTHER DECEASED ____PARENTS DIVORCED ____ADOPTED (CHILD UNAWARE)

STUDENT LIVES WITH:

(CIRCLE ONE) PARENTS GUARDIAN IF GUARDIAN, STATE RELATIONSHIP:________________

FULLNAMES OF SIBLINGS AND AGES:

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(NAME) (AGE) (SCHOOLS ATTENDED/ATTENDING)

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(NAME) (AGE) (SCHOOLS ATTENDED/ATTENDING)

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(NAME) (AGE) (SCHOOLS ATTENDED/ATTENDING)

BRIEFLY DESCRIBE YOUR CHILD:

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WHAT ARE YOUR CHILD’S GREATEST STRENGTHS?

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WHAT ARE YOUR CHILD’S HOBBIES AND INTERESTS?

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DOES YOUR CHILD PARTICIPATE IN ANY AFTER-SCHOOL ACTIVITIES?

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DOES YOUR CHILD HAVE ANY SPECIAL NEEDS OR LEARNING CHALLENGES:

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PARENT INFORMATION:

FATHER

TITLE: DR. MR. NAME:______________________________________

HEBREW NAME:______________________________________________

HOME ADDRESS:______________________________________________

CITY, STATE, ZIP:_______________________________________________

HOME PHONE:________________________________________________

EMAIL:_______________________________________________________

COUNTRY OF BIRTH:____________________________________________

SCHOOLS ATTENDED: ___________________________________________

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JEWISH EDUCATION:____________________________________________

LANGUAGE SPOKEN AT HOME:____________________________________

CELLPHONE:___________________________________________________

OCCUPATION:__________________________________________________

COMPANY NAME:_______________________________________________

BUSINESS ADDRESS:_____________________________________________

CITY, STATE, ZIP:________________________________________________

BUSINESS PHONE:_______________________________________________

SYNAGOGUE AFFILIATION:________________________________________
MOTHER

TITLE: DR. MRS. MS.

NAME:_____________________________________________________

HEBREW NAME:______________________________________________

HOME ADDRESS:______________________________________________

CITY, STATE, ZIP:_______________________________________________

HOME PHONE:________________________________________________

EMAIL:_______________________________________________________

COUNTRY OF BIRTH:____________________________________________

SCHOOLS ATTENDED: ___________________________________________

_____________________________________________________________

_____________________________________________________________

JEWISH EDUCATION:____________________________________________

LANGUAGE SPOKEN AT HOME:____________________________________

CELLPHONE:___________________________________________________

OCCUPATION:__________________________________________________

COMPANY NAME:_______________________________________________

BUSINESS ADDRESS:_____________________________________________

CITY, STATE, ZIP:________________________________________________

BUSINESS PHONE:_______________________________________________

SYNAGOGUE AFFILIATION:________________________________________
GRANDPARENT INFORMATION: PLEASE PROVIDE INFO FOR US TO INVITE THEM TO SPECIAL EVENTS
AND TO SEND NOTES FROM THEIR GRANDCHILDREN.

PATERNAL:

NAME ____________________________________________________________________________

ADDRESS __________________________________________________________________________

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EMAIL ____________________________________________________________________________

PHONE ____________________________________________________________________________

MATERNAL:

NAME ____________________________________________________________________________

ADDRESS __________________________________________________________________________

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EMAIL _____________________________________________________________________________

PHONE _____________________________________________________________________________