How to Apply - Miami Beach’s Center for Torah Education

New Student Application

"*" indicates required fields

Family Information

Family Name*

Father's Name*

First Last

Mother's Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Father's Email*

Mother's Email*

Father's Cell Phone*

Mother's Cell Phone*

Father's Profession*

Mother's Profession*

Marital Status*

Married

Separated

Divorced

Widowed

Name of Shul the Family Attends*

Family Rav's Name*

Family Rav's Cell Phone*

Does your child have any living grandparents?

Yes

No

Grandparents

Title & Name (first and last)

Address

Phone #

Does your child have any living great-grandparents?

Yes

No

Great-Grandparents

Title & Name (first and last)

Address

Phone #

Student Information

Information About the Child(ren) You Are Registering*

English Name

Hebrew Name

How does he like to be called?

Date of Birth

Previous School or Program

Birth Country / Language Spoken at Home

Grade Applying to

Emergency Contact Name*

Emergency Contact Cell Phone #*

Are there any allergies or medical conditions we should be aware of?*

Yes

No

If yes, please describe the allergies or medical conditions:

Health Forms (PDF Files)*

Health forms are obtained from Florida pediatricians and must be submitted with immunization records before your child can receive admission card to school.

Drop files here or

Accepted file types: pdf, Max. file size: 32 MB.

Additional Information

Additional Message or Comments

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