email ha logo.png 

We are currently accepting application forms for the coming school year. Please fill out ALL fields of this form.

If you have any questions or concerns you'd like to discuss, please contact us.

Please note that one registration form per child is needed.

CLICK HERE to Download a PDF Version of the Enrollment Form.

Please provide the following information about your CHILD.
 
Child's name     Date of birth

First Name
Last Name
Hebrew Name
DD/MM/YYYY
       
Address      

Street Address
City


Postal / Zip Code
       
Phone Number     Extended Care Needed   Summer Only

Cell Phone
Home Phone		   School Year (10 month)   Year-Round Program (12 month)

 

Describe any Illnesses, diseases, special needs, or allergies, if applicable, that may affect your child’s general health, school, work, or athletics program participation (or write “N/A")
 
Pediatrician Name: Pediatrician Phone:

 

What are your child’s most pronounced interests?
 

Please provide the following information about your child’s previous school & education history:
 
Previous School Name School Phone
Address  

Street Address
City


Postal / Zip Code
 
Hebrew Language Education & Level (Describe):

 

Please provide the following information about your family:
For Father
     
       
Name      

First Name
Last Name		    
 Cell Phone Number       
Email

Occupation

   
       
Home Address      

Street Address
City


Postal / Zip Code
       
Work Address      

Street Address
City


Postal / Zip Code
       
       

Please provide the following information about your family:
For Mother
     
       
Name      

First Name
Last Name		    
 Cell Phone Number       
Email

Occupation

   
       
Home Address      

Street Address
City


Postal / Zip Code
       
Work Address      

Street Address
City


Postal / Zip Code
       
       
Other Emergency Contact #1
       
Name      

First Name
Last Name		    
       
Relation to child      
     
       
Phone Numbers      

Cell Phone
Daytime Phone
Other Phone		  
       
Other Emergency Contact #2
       

First Name
Last Name		    
       
Relation to child      
     
       
Phone Numbers      

Cell Phone
Daytime Phone
Other Phone		  
       
Other children living with the enrolling student
       
Name Age Name Age

  Application Fee:
Credit Card Number Expiration Date
Security Code Charge Amount 
 $ 150.00 Non-refundable
Name on Card  
First Name Last Name
Emergency Release & Permission Form

If an emergency arises and none of the above emergency contacts can be reached in a timely manner, I hereby give the Hebrew Academy staff permission to take whatever measures it deems appropriate for the situation.

I/we hereby give permission for my/our child to participate in all school activities, join in class and school field trips on and beyond school property, and for my/our child to be recorded on photograph & video while participating in Hebrew Academy activities, and for such photographs & videos to be used in Hebrew Academy materials & resources of any type.
   
Parent/ Guardian Name

Date

Full Name
DD/MM/YYYY
   
Parent/Guardian Name

Date

Full Name

DD/MM/YYYY
   


At the Hebrew Academy, we have a sincere interest in meeting the needs of every child. Upon receiving your completed enrollment form, an interview for you and your child will be arranged at your convenience.

Please make sure your child had their HRS medical form before the school year begins. Please return your HRS medical form (Florida School Physical) along with this completed enrollment form if you did not fill out online to our below address, or fax to: (813) 962-1123. Thank you for your interest in Hebrew Academy of Tampa. We look forward to partnering with you for this next exciting step in your child’s academic development!