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2016 - 2017 Temple Oheb Shalom Religious School Registration
Parent and Family Information
*First Name Primary Parent/Guardian
*Last Name Primary Parent/Guardian
Informal Name or Nickname
*Relationship to Student(s):
*First Parent/ Guardian E-Mail:
Valid e-mail is required
*Primary / Home Phone:
Format: 410-555-5555
*Cell Phone:
Format: 410-555-5555
Would You Like to Be Contacted VIA Text Message for School Closings and Other Important or Emergency Notifications?
*Primary Parent/Guardian Text?
YES
NO
*Home Address:
*City:
*State:
Choose a State
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*Zip Code:
*Are You a Member of Temple Oheb Shalom:
Choose a
Are You a Member of Temple Oheb Shalom
Yes
No
*Which Best Describes Your Situation:
Please Choose One
Learning Ladder Family
Open Enrollment
In The Process of Becomming a Member/Prospective Member
Other
If Other Please Explain:
First Name Second Parent/Guardian
Last Name Second Parent/Guardian
Informal Name or Nickname:
Relationship to Student(s)
Second Parent E-Mail:
Valid e-mail is required
Primary / Home Phone (if different from above):
Format: 410-555-5555
Cell Phone:
Format: 410-555-5555
Would You Like to Be Contacted VIA Text Message for School Closings and Other Important or Emergency Notifications?
Second Parent/Guardian Text?
YES
NO
Address(if different from above):
City:
State:
Choose a State
Maryland
Pennsylvania
Delaware
District of Columbia
Florida
Virginia
Zip Code:
Emergency Contact Information (In The Event a Parent/Guardian Cannot be Reached) :
*Emergency Contact First Name:
*Emergency Contact Last Name:
*Home Phone:
Cell Phone:
*Address:
*City:
*State:
Choose a State
Maryland
Pennsylvania
Delaware
District of Columbia
Virginia
Florida
California
*Zip Code:
Registration and Permission Information
By registering our child(ren) below, we agree to make every effort to attend all scheduled classes, programs, and events and agree to pay school tuition as per the published or agreed upon fee schedule.
PLEASE CLICK HERE FOR THE CURRENT FEE SCHEDULE
I also hereby give permission for my child(ren) to accompany his/her/their class on Religious School field trips during the school year. I also give permission for my child(ren) to be transported to and from the field trip site. I understand that should a trip be planned in which I do not wish my child(ren) to participate, I can contact the Religious School office to have my child(ren) excluded.
***SELECTION REQUIRED BELOW***
I give permission for my chid(ren) to be photographed/video-taped/interviewed for publicity by Temple Oheb Shalom during the school year:
*
Yes
No
*Please Note* All students are subject to photography/video-tapping for educational purposes or for any reason in large group settings.
I would like my contact information as stated above to be included in the Parent Directory that will be distributed to all families in the Religious School. Please Include: (check all that apply)
Name
Address
Phone
E-mail
Other/Alternative Information to Include in the Directory
If Different From Above
Please DO NOT include any of my information in the Parent Directory
My signature below confirms that the information provided herein is true and complete. The student(s) listed below has (have) my permission to engage in all school activities except as noted. The school has my permission to provide routine first aid, and seek emergency medical or dental treatment. If the student is not covered by medical and/or dental insurance, I agree to pay all costs incurred for emergency treatment. In the event of a medical or dental emergency, the school may transport the student for treatment. In the event of an emergency where none of the adults listed above are available, I authorize and give my consent to the school to obtain any necessary medical or dental treatment, including hospitalization and surgery, from a licensed health care provider or facility. This form may be photocopied for school-sponsored trips.
Parent/Guardian Electronic Signature
***REQUIRED***
*Parent Guardian Electronic Signature:
*Number of Students Registering for Temple Oheb Shalom Religious School:
Select Number
1
2
3
4
5
Student 1 Information
*Student`s First Name:
*Student`s Last Name:
Student`s Informal Name or Nickname:
Is This Child New To Temple Oheb Shalom Religious School?
*Please Choose:
Yes
No
FIRST TIME STUDENT?
Has This Child Attended Any Religious School in the Past?
*Other School?
Yes
No
*Please Enter the Name of Previous Religious School, City, State, And Years Attended:
*Registering for Religious School Grade:
Select Grade
Pre-K (Part-Time)
Pre-K (Full Time)
K
1
2
3
4
5
6
7
*Student`s Date of Birth:
Format: mm/dd/yyyy
*Student`s Gender:
Select Gender
Male
Female
*Student`s T-Shirt Size:
Choose One
Youth X-Small
Youth Small
Youth Medium
Youth Large
Youth X-Large
Adult Small
Adult Medium
Student`s E-Mail (optional)
For Those Students Who Have thier Own E-Mail Adress (Optional)
(Student E-Mails Will Not Be Included In The Directory)
*Student`s Secular School Attending in 2016 - 2017::
*Student`s Grade in Secular School for the 2016 - 2017 School Term:
Student`s Classmate/Friend Request
*Please Note* Every effort will be made to honor your child`s request. Requested are honored for all classes in grades K-3, and for Judaic classes only in grades 4-6.
Student`s Photo
Photo is Used for Security and Identification Purposes Only.
PLEASE MAKE EVERY EFFORT TO INCLUDE A PHOTO.
Student 1 Health and Safety Information
Does this student have any potentially life threatening allergies (at risk for Anaphylaxis) and/or has epinephrine been prescribed for your child?
* Life Threatening Allergy?
Yes
No
*What Triggers This Life Threatening Allergic Reaction?
Please Download The Allergy Action Plan Form below. Your registration will not be processed until this form is completed and signed by BOTH a parent/guardian AND Heath Care Provider. Please note that we require a new allergy action form each year your child attends Religious School.
http://www.myhebrewschool.net/Forms/Allergy.pdf
If there are any other special circumstances or considerations pertaining to the health and/or well-being of this child at Temple Oheb Shalom Religious School please provide a brief explanation below.
*Please Note* Temple Oheb Shalom Does Not Hold or Store Student Medications or Prescriptions Including Epi-pens. Please send and necessary emergency medications (i.e. Asthma Inhaler, Epi-Pen, Benadryl, etc.) EACH and EVERY school session with your child.
STOP! - IF YOU ARE ONLY REGISTERING ONE STUDENT FOR RELIGIOUS SCHOOL PLEASE SCROLL DOWN TO THE END OF THE FORM AND PRESS SUBMIT.
Student 2 Information
Student 2 First Name:
Student 2 Last Name:
Student 2 Informal Name or Nickname
Is Student 2 New To Temple Oheb Shalom Religious School?
*Please Choose for Student 2:
Yes
No
FIRST TIME STUDENT?
Has Student 2 Attended Any Religious School in the Past?
*Other School for Student 2?
Yes
No
*Please Enter the Name of Previous Religious School, City, State, And Years Attended:
Student 2 Registering for Religious School Grade:
Select Grade
Pre-K (Part-Time)
Pre-K (Full Time)
K
1
2
3
4
5
6
7
Student 2 Date of Birth:
Format: mm/dd/yyyy
Student 2 Gender:
Select Gender
Male
Female
Student 2 T-Shirt Size:
Choose One
Youth X-Small
Youth Small
Youth Medium
Youth Large
Youth X-Large
Adult Small
Adult Medium
Student 2 E-Mail (optional)
For Those Students Who Have thier Own E-Mail Adress (Optional)
(Student E-Mails Will Not Be Included In The Directory)
Student 2 Secular School Attending in 2016 - 2017:
Student 2 Grade in Secular School for the 2016 - 2017 School Term:
Student 2 Classmate/Friend Request
*Please Note* Every effort will be made to honor your child`s request. Requested are honored for all classes in grades K-3, and for Judaic classes only in grades 4-6.
Student 2 Photo
Photo is Used for Security and Identification Purposes Only.
PLEASE MAKE EVERY EFFORT TO INCLUDE A PHOTO.
Student 2 Health and Safety Information
Does this student have any potentially life threatening allergies (at risk for Anaphylaxis) and/or has epinephrine been prescribed for your child?
* Student 2 Life Threatening Allergy?
Yes
No
*What Triggers This Life Threatening Allergic Reaction?
Please Download The Allergy Action Plan Form below. Your registration will not be processed until this form is completed and signed by BOTH a parent/guardian AND Heath Care Provider. Please note that we require a new allergy action form each year your child attends Religious School.
http://www.myhebrewschool.net/Forms/Allergy.pdf
If there are any other special circumstances or considerations pertaining to the health and/or well-being of this child at Temple Oheb Shalom Religious School please provide a brief explanation below.
*Please Note* Temple Oheb Shalom Does Not Hold or Store Student Medications or Prescriptions Including Epi-pens. Please send and necessary emergency medications (i.e. Asthma Inhaler, Epi-Pen, Benadryl, etc.) EACH and EVERY school session with your child.
STOP! - IF YOU ARE ONLY REGISTERING TWO STUDENTS FOR RELIGIOUS SCHOOL PLEASE SCROLL DOWN TO THE END OF THE FORM AND PRESS SUBMIT.
Student 3 Information
Student 3 First Name:
Student 3 Last Name:
Student 3 Informal Name or Nickname:
Is Student 3 New To Temple Oheb Shalom Religious School?
*Please Choose for Student 3:
Yes
No
FIRST TIME STUDENT?
Has Student 3 Attended Any Religious School in the Past?
*Other School for Student 3?
Yes
No
*Please Enter the Name of Previous Religious School, City, State, And Years Attended:
Student 3 Registering for Religious School Grade:
Select Grade
Pre-K (Part-Time)
Pre-K (Full Time)
K
1
2
3
4
5
6
7
Student 3 Date of Birth:
Format: mm/dd/yyyy
Student 3 Gender:
Select Gender
Male
Female
Student 3 T-Shirt Size:
Choose One
Youth X-Small
Youth Small
Youth Medium
Youth Large
Youth X-Large
Adult Small
Adult Medium
Student 3 E-Mail (optional)
For Those Students Who Have thier Own E-Mail Adress (Optional)
(Student E-Mails Will Not Be Included In The Directory)
Student 3 Secular School Attending in 2016 - 2017:
Student 3 Grade in Secular School for the 2016 - 2017 School Term:
Student 3 Classmate/Friend Request
*Please Note* Every effort will be made to honor your child`s request. Requested are honored for all classes in grades K-3, and for Judaic classes only in grades 4-6.
Student 3 Photo
Photo is Used for Security and Identification Purposes Only.
PLEASE MAKE EVERY EFFORT TO INCLUDE A PHOTO.
Student 3 Health and Safety Information
Does this student have any potentially life threatening allergies (at risk for Anaphylaxis) and/or has epinephrine been prescribed for your child?
* Student 3 Life Threatening Allergy?
Yes
No
*What Triggers This Life Threatening Allergic Reaction?
Please Download The Allergy Action Plan Form below. Your registration will not be processed until this form is completed and signed by BOTH a parent/guardian AND Heath Care Provider. Please note that we require a new allergy action form each year your child attends Religious School.
http://www.myhebrewschool.net/Forms/Allergy.pdf
If there are any other special circumstances or considerations pertaining to the health and/or well-being of this child at Temple Oheb Shalom Religious School please provide a brief explanation below.
*Please Note* Temple Oheb Shalom Does Not Hold or Store Student Medications or Prescriptions Including Epi-pens. Please send and necessary emergency medications (i.e. Asthma Inhaler, Epi-Pen, Benadryl, etc.) EACH and EVERY school session with your child.
STOP! - IF YOU ARE ONLY REGISTERING 3 STUDENTS FOR RELIGIOUS SCHOOL PLEASE SCROLL DOWN TO THE END OF THE FORM AND PRESS SUBMIT.
Student 4 Information
Student 4 First Name:
Student 4 Last Name:
Student 4 Informal Name or Nickname:
Is Student 4 New To Temple Oheb Shalom Religious School?
*Please Choose for Student 4:
Yes
No
FIRST TIME STUDENT?
Has Student 4 Attended Any Religious School in the Past?
*Other School for Student 4?
Yes
No
*Please Enter the Name of Previous Religious School, City, State, And Years Attended:
Student 4 Registering for Religious School Grade:
Select Grade
Pre-K (Part-Time)
Pre-K (Full Time)
K
1
2
3
4
5
6
7
Student 4 Date of Birth:
Format: mm/dd/yyyy
Student 4 Gender:
Select Gender
Male
Female
Student 4 T-Shirt Size:
Choose One
Youth X-Small
Youth Small
Youth Medium
Youth Large
Youth X-Large
Adult Small
Adult Medium
Student 4 E-Mail (optional)
For Those Students Who Have thier Own E-Mail Adress (Optional)
(Student E-Mails Will Not Be Included In The Directory)
Student 4 Secular School Attending in 2016 - 2017:
Student 4 Grade in Secular School for the 2016 - 2017 School Term:
Student 4 Classmate/Friend Request
*Please Note* Every effort will be made to honor your child`s request. Requested are honored for all classes in grades K-3, and for Judaic classes only in grades 4-6.
Student 4 Photo
Photo is Used for Security and Identification Purposes Only.
PLEASE MAKE EVERY EFFORT TO INCLUDE A PHOTO.
Student 4 Health and Safety Information
Does this student have any potentially life threatening allergies (at risk for Anaphylaxis) and/or has epinephrine been prescribed for your child?
* Student 4 Life Threatening Allergy?
Yes
No
*What Triggers This Life Threatening Allergic Reaction?
Please Download The Allergy Action Plan Form below. Your registration will not be processed until this form is completed and signed by BOTH a parent/guardian AND Heath Care Provider. Please note that we require a new allergy action form each year your child attends Religious School.
http://www.myhebrewschool.net/Forms/Allergy.pdf
If there are any other special circumstances or considerations pertaining to the health and/or well-being of this child at Temple Oheb Shalom Religious School please provide a brief explanation below.
*Please Note* Temple Oheb Shalom Does Not Hold or Store Student Medications or Prescriptions Including Epi-pens. Please send and necessary emergency medications (i.e. Asthma Inhaler, Epi-Pen, Benadryl, etc.) EACH and EVERY school session with your child.
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