Charles E. Smith Jewish Day School

Student Information

Student Name

First

Middle

Last

Suffix

Preferred Name

Gender

Date of Birth

mm/dd/yyyy

Applying For Grade

For Admission Year

Is the student being raised as a Jew? (Why do we ask this? The purpose of CESJDS is to ensure a vibrant Jewish future through the growth of confident, compassionate thinkers who engage the world through a Jewish lens. To that end, all students at CESJDS are being raised as Jews.)

Yes No

Parent / Guardian

Relationship to Student

Parent Name

Title

First

Middle

Last

Suffix

Preferred Name

Phone

Type

Number

Email

Parent / Guardian 2

Does the applicant have a second parent/guardian who lives in this household?

Yes No

Relationship to Student

Parent Name

Title

First

Middle

Last

Suffix

Preferred Name

Phone

Type

Number

Email

Referral Method

Name of Current or Past Parent?

Please Specify