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Prospective Family Form 2027–28

Prospective Family Form 2027–28
Dear Parents,

We are honored that you are considering LCLA (Bais Chaya Mushka and Cheder Menachem) for your child.

Please complete the form below to request an appointment to meet. This form is not an application and is no guarantee of admittance.
Family Information
Parent/Guardian 1 Full Name*
Parent/Guardian 2 Full Name
First Name Last Name
Parent/Guardian 1 Email*

Home Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Primary Phone Number*
Shul Affiliation
Parent/Guardian 2 Email
Which school are your children currently attending?
If changing schools, what is the reason?
If applicable, what schools are your other children attending?
Rabbi Name
School*
Rabbi Phone Number
How did you hear about LCLA?
Child Information
Number of Children*
Child 1 Full Name*
First Name Last Name
Child 1 Birth Date*

Month Day Year
Child 1 Grade Entering*
Child 2 Full Name
First Name Last Name
Child 2 Birth Date

Month Day Year
Child 2 Grade Entering
Child 3 Full Name
First Name Last Name
Child 3 Birth Date

Month Day Year
Child 3 Grade Entering
Should be Empty:

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