Registration

Address

Hebrew Name
Birth Date

Month Day Year
School
Grade Entering
Is the natural mother and maternal grandmother of the student Jewish?

YesNo
Have there been any conversions or adoptions in the family?

YesNo
If yes, please explain
Parent Information
Mother's Name
Phone Number

Area Code Phone Number
E-mail
Father's Name
E-mail
Phone Number

Area Code Phone Number
Emergency Information
Does your child have any allergies or medical condition we should be aware of? Please explain.
Emergency Contact
Phone Number

Area Code Phone Number
As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Glastonbury Jewish Academy to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Glastonbury Jewish Academy personnel will try, but are not required, to communicate with me prior to such treatment.

Yes
Parental Consent
I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties.

Yes
I allow my child to be photographed while participating in Glastonbury Jewish Academy activities and that these pictures may be used for marketing purposes.

YesNo
Tuition Payment Options

$850 Full Payment10 monthly payments $85Please contact me to discuss scholarship

Payment

Credit Card Check

Postal / Zip Code

Country

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Programs

Student Information