Family Information
 
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Child Information
Name Child Goes By *
Last Name *

Gender*
Birthdate*

Grade Applying For*
Child Lives With *

Home Address*
City *

State *
Zip Code *

Current School*
Date Student Entered Current School*

Current School Address *

Camps/Summer Programs Previously Attended in the Past Two Years (List Dates Attended)*

How did you learn about Brauser Maimonides Academy *

Do you have any other relatives who currently attend, have attended or graduated from our school? If so, please elaborate.*

Other Child/Children
Please enter child's/children's name, birthdate, and current school:

Parent/Guardian 1 Information
Title (please select one)*
First Name*
Last Name*

Gender *
Relationship to Applicant *

Marital Status *
Custodial Rights *

Home Address*

City*
State*
Zip*

Cell Phone*
Primary Email*

Employment (please select one)*
Occupation and Title*

Type of Business*
Business Name*

Are you a BMA alumnus?*
What year did you graduate from BMA?

Parent/Guardian 2 Information
Title (please select one)
First Name
Last Name

Gender
Relationship to Applicant

Marital Status
Custodial Rights

Home Address (if different than child)

City
State

Zip Code
Cell Phone
Primary Email

Employment (please check one)
Occupation & Title

Type of Business
Business Name

Are you a BMA alumnus?
What year did you graduate from BMA?

Synagogue or Jewish affiliation
Name of Synagogue *

Name of Rabbi *

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