Beth Tfiloh Dahan Community School

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About the Student

Name

First

Middle

Last

Suffix

Preferred Name

Gender

Date of Birth

mm/dd/yyyy

Current Grade

Interested in Grade

For the Fall of

*To start in September, the child MUST be two years old by 09/01/2023.

*To start in February, the child MUST be two years old by 02/01/2023.

*To start in November, the child MUST be two years old by 11/01/2024.

*To start in September, the child MUST be three years old by 09/01/2023.

*To start in September, the child MUST be four years old by 09/01/2023.

Current School

About the Parent/Guardian

Name

Title

First

Middle

Last

Suffix

Preferred Name

Relationship to Student

Primary Phone (xxx-xxx-xxxx)

Type

Number

Secondary Phone (xxx-xxx-xxxx)

Type

Number

Email

Is there an additional parent in this household?

Yes No

Name

Title

First

Middle

Last

Suffix

Preferred Name

Relationship to Student

Primary Phone (xxx-xxx-xxxx)

Type

Number

Secondary Phone (xxx-xxx-xxxx)

Type

Number

Email

Mailing Address

Broadening Horizons

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