• Family Packet

    2025-2026
  • Child/Childrens Address*
  • Are both biological parents living?*
  • Parents marital status?*
  • Child lives with?*
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  • Parent/Guardian 1*
  • Parent/Guardian 2
  • Emergency Contact #1 (should be different than the parent/guardian)*
  • Emergency Contact #2 (should be different than the parent/guardian)*
  • Primary Doctor*
  • AUTHORIZATION FOR EMERGENCY TREATMENT: In case of an emergency where I cannot be reached, I hereby authorize Mill Basin Yeshiva Academy to arrange for appropriate immediate medical attention for my child/children at the nearest medical facility (doctor, hospital, etc).*
  • Medical Information*
  • PERMISSION SLIP: I hereby grant permission for my child/children to accompany his/her teacher and other supervisory personnel, where necessary, on neighborhood walks at any time during the 2025-2026 school year.*
  • CONSENT TO PHOTOGRAPH, FILM, OR VIDEOTAPE A STUDENT FOR SCHOOL USE (e.g. educational, public service, marketing or health awareness purposes): I give permission for my child/children to be photographed and/or videotaped throughout the school year at various performances, ceremonies, and numerous holiday events. I understand that these photographs will be used on social media and various other places.*
  • How will your child/children be coming to school?*
  • How will your child/children be going home?*

  • **Important**

    Children may only walk home if they are at least 12 years old or if they are accompanied by an older sibling that is at least 12 years old (early childhood students are excluded from this). Parents must understand that if they choose city bus, driver, or walkers, the school and the administration is no longer responsible once the child is outside of our building. If one of our staff members is hired privately by parent to drive your children home, parents must accept that the school is not responsible for the child or the staff member once they leave the building. If you would like to allow your children to leave with a sibling that is over 12 years old, please fill out the form below.

  • I, the parent and guardian of the children listed above, confirm that I have read and agreed to the rules and conditions in the student handbook. I also confirm that everything in this packet is true. I will notify the school with any changes or updates through e-mail or written & signed letters.

  • Please click the link below to view the student Handbook

    Student Handbook 

  • Today's Date*
     - -
    2 digit month, 2 digit day, 4 digit year
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