General Information Form
Father/Guardian 1

First Name*
Last Name*

Email Address*
Cell Phone*

Mother/Guardian 2

First Name*
Last Name*
Maiden Name*

Email Address*
Cell Phone*

Home Address

Street Address*

City*
State*
Zip*

How Did You Hear About Us?*

What interests you about Barkai?*

Student Information
First Name*
Last Name*

Gender*
Date of Birth*
Grade Level of Interest*

Grade Placement
Orot - child born by 10/31/2023
Ganon - child born by 10/31/2022
Gan - child born by 10/31/2021
Mekhinah - child born by 10/31/2020
School Year*
Current School/Program*

Sibling Information
First Name
Last Name

Gender
Date of Birth

Current Grade
Current School/Program

Personal Tour Request
I would like to be contacted to schedule a tour of Barkai