Bais Chana International, Extraordinary Jewish Learning

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Teen Application Form

Please complete and submit the form below. Once you submit this form, you will be directed to the online payment form.

Please return to the Registration Process page to complete your application, or to apply for a partial or complete scholorship.

If you have any questions call our office at 718.604.0088 or email us

First Name

Middle Name

Last Name

Address (Include Apt. #)

City

Zip

If outside the USA, please enter your State/Province here

Country

Date of Birth

Home Telephone

Other Telephone

Email Address

Hebrew Name

Mother's Hebrew Name

Father's Name

Father's Employer Business Phone

Mother's Name

Mother's Employer Business Phone

Cell Phone

Who referred you to Bais Chana?

Telephone number of the person who referred you.

Which session are you attending? Write the month and location.

If applicable, name and contact number of sister/friend also registering.

Name Phone

SCHOOL INFORMATION

School Name School Telephone

Address

City

Zip

Your Grade This Year

School Contact Person (Teacher, Counselor, Etc.)

EMPLOYER INFORMATION (if applicable)

Employer's Name

Contact Person

Address

City

Zip

Employer's Telephone

EMERGENCY CONTACTS

Name

Telephone

Relationship to you

Name

Telephone

Relationship to you

What are your special interests and talents? (e.g. music, sports, drama, politics, etc.)

In which extracurricular activities have you been involved?

What are you looking forward to the most at Bais Chana?

Is there anything else you'd like us to know about you?

We will contact you to arrange an interview, either in person or by phone. What is the best time to reach you at home?

AM or PM?

= Required

Meet Kayla from Seattle. She’s got questions about life, about purpose and about her role as a woman. more women's profiles

Meet Dani. She attends a private school for math and science near Chicago, and really enjoyed meeting girls from around the world the summer she spent at Bais Chana. more teen profiles

Meet Yanna from Uzbekistan. Everything piqued her interest at Bais Chana – especially the waverunning. more student profiles

Following In Their Footsteps
Wondering where your favorite Bais Chana teachers will be over the next month? Track their footsteps here and catch up with them at classes, workshops, weekends and community events all over the world. this month’s calendar