Online Application

Student's Name*
First Last
Hebrew Name
Preferred or Nickname
Date of Birth*
MM slash DD slash YYYY
City of Birth
Grade Applying For*
Gender*
Parent/Guardian 1
Name*
First Last
Relationship to Student*
Cell Number*
Home Number
Work Number
Email*
Home Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Occupation/Employer*
Parent/Guardian 2 (if applicable)
Name
First Last
Relationship to Student
Cell Number
Home Number
Work Number
Email
Home Address (Parent/Guardian 2 if different)
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Occupation/Employer
Child's Living Situation
If other, please explain:
Preferred numbers to call
- Parent/Guardian 1 Cell
- Parent/Guardian 2 Cell
- Parent/Guardian 1 Home
- Parent/Guardian 2 Home
- Parent/Guardian 1 Work
- Parent/Guardian 2 Work
Best Time to Call
Name of Sibling #1
First Last
Date of Birth
MM slash DD slash YYYY
Grade/School Attending
Name of Sibling #2
First Last
Date of Birth
MM slash DD slash YYYY
Sibling #2 - Grade/School Attending
Please list additional siblings and date of birth:
School History (Please list all schools including preschools and years attended)*
Please describe your child and let us know of any special strengths and/or challenges*
Does your child have any physical, educational, or psychological needs which may require accommodation? If so, please describe*
Why are you considering the Contra Costa Jewish Day School for your child's education?*
How did you hear about the Contra Costa Jewish Day School?*
- Web Search
- Information Meeting
- Word of Mouth
- From your preschool
- Other
Are you affiliated with a congregation? If so, please indicate
I confirm that the information provided to CCJDS concerning my child for the admissions process is accurate*
- Yes
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925-284-8288
admissions@ccjds.org
925-284-8289
955 Risa Road
Lafayette, CA 94549

Online Application

Parent/Guardian 1

Parent/Guardian 2 (if applicable)

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