ADMISSION APPLICATION FORM

Parent 1 First Name *

Parent 1 will be the primary contact we will use for your application.

Parent 1 Last Name *

Parent 1 will be the primary contact we will use for your application.

Parent 1 Cell Number *

Parent 1 Email *

CELC Parent 1 Occupation

CELC Parent 1 Firm Name

Child's First Name *

Child's Last Name *

Child's Date of Birth *

Child's Place Of Birth

Child's Gender *

What name would you like us to use when addressing your child?

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Cell Number

Parent 2 Occupation

Parent 2 Firm Name

Please list siblings' names, ages and schools attending.

Is the child's mother Jewish? *

Are there any conversions In the family? *

Are there any adoptions In the family? *

Is your family affiliated with a congregation? If yes, which one?

Please share any additional comments you may have.