Re-Registration

Shearim Torah HS For Girls
2013-4 Re-Registration Form

* Indicates required field

Name *

First

Last

Address *

Line 1

Line 2

City

State

Zip Code

Country

Phone Number *

Email *

Grade in 2013-4 *

Grade 10 Grade 11 Grade 12

Parents' Martial Status *

Student Lives With *

Father's Occupation *

Employer Name *

Employer Phone Number *

Mother's Occupation *

Employer Name *

Phone Number *

Emergency Contact 1 *

First

Last

Phone Number *

Emergency Contact 2 *

First

Last

Phone Number *

Submit

Registration - $125
Student Activity Fee - $80
Textbook Fee - $300
(Reduced if student is returning textbooks)
PTO Dues - $25