Religious School Registration Religious School Registration Student Information Student Information Student's Name * Student's Name First First Last Last Date of Birth * Hebrew Name * Class Registration Class Registration Select a class * Gan (Kindergarten S) Aleph (1st Grade S) Bet (2nd Grade S/T) Gimmel (3rd Grade S/T/Th) Hay (5th Grade S/T/Th) Vav (6th Grade S/T/Th) Zayin (7th Grade S/T/Th) S=Sunday 9:00 - 11:30am T=Tuesday 4:30 - 6:15pm Th=Thursday 4:30 - 6:15pm Hebrew Workshop Registration Hebrew Workshop Registration I would like to register my child(ren) for one-on-one or a small group Hebrew Worshop that will take place virtually, outside of Religious School class time. Students will be matched with a Workshop Leader at the beginning of the year. Leader and student will find a mutually agreeable time to meet each week. Hebrew Workshop Registration * Yes No Previous Jewish Education Previous Jewish Education Name of School Location Dates In Case of Emergency In Case of Emergency In case of emergency, every effort will be made to contact the parents. If neither parent is available, please contact the following individual. Please note that this person must be local. Name Relation to Student Mobile/Home Phone Family Information Family Information Parent 1 * <b>Parent 1</b> First Name First Name Last name Last name Parent 2 <b>Parent 2</b> First Name First Name Last Name Last Name Hebrew Name Hebrew Name Home Address * <b>Home Address</b> <b>Home Address</b> <b>Home Address</b> City City State/Province AlabamaAlaskaArkansasArizonaCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyoming State/Province Zip/Postal Zip/Postal Parent 1: Profession/Title Parent 2: Profession/Title Business Phone Business Phone Mobile Phone * Mobile Phone Email * Email Pick-up Authorization Pick-up Authorization In order to protect the safety and well-being of your child, we ask that you designate individuals other than parents who are authorized to pick up your child. Name Name Relation to Student Relation to Student Phone Phone Travel Home Travel Home Please choose one of the following options and sign below. * My child has permission to walk home from the Family School. I understand that my child will be dismissed at 11:30am on Sundays and 6:15 pm on Tuesday/Thursday from Moriah. My child does not have permission to walk home from the Family School. Signature * signature keyboard Clear Health & Safety Information Health and Safety Information Does your child take any mediation on a regular basis? Does your child suffer from any allergies (especially food allergies)? Please be specific. Does your child wear glasses? Is your child vaccinated? * Yes No Has your child received the COVID vaccine? * Yes No If yes, on what dates did they receive the COVID vacination (please list all) Getting to Know Your Child Getting to Know Your Child Tell us how your child likes to learn: please provide us with a description of your child’s learning style, and any ways that we might support your child’s learning. How does your child like to learn Does your child have any special needs? Does your child receive additional support in school (academic, social, emotional, etc)? Please explain: Does your child have any special needs... Student Photograph Student Photograph Please attach a recent photograph of your child. A photograph will help your child’s teacher to get to know your child before school begins. Thank you very much in advance. Please upload a photo of your child here * Drop a file here or click to upload Choose File Maximum file size: 516MB If you are human, leave this field blank. Submit Δ
