Person Filling out Form

Student Information

Parent/Guardian Information

Emergency Contact Information

Please list the name and contact information for 2 emergency contacts below. 

Medical Information

It is essential for our Religious School to have the following information to serve your child. This information is held to the strictest confidence and for office use only.

Photography 

This is an application for the registration of my child to Talmud Torah the Ahavath Torah Congregation's South Area Religious School. It is our understanding that this is merely an application and registration is not completed until the Financial Secretary of Ahavath Torah Congregation has certified that all financial requirements of the Congregation have been satisfied.

I hereby authorize Ahavath Torah Congregation to contact my child's Pediatrician, in the event I cannot be reached and such a call is necessary. Should the Pediatrician not be reached, I authorize the contact to another physician or Emergency Services.