2022-23 ST Chavaya Religious School Registration - Form

* Is your family new to our school?

Please Select OneNoYes

* Are you enrolling as a member or a non-member family?

Please Select OneMemberNon-MemberPlease select the correct tuition category in the student grade enrollment section.

Section A: Family Contact Information

* First Name (Primary)

* Last Name (Primary)

* Email (Primary)

* Phone (Primary)

* Relationship to Student(s) (Primary)

* Street Address (Primary)

Street Address Line 2 (Primary)

* City (Primary)

* State (Primary)

* ZIP (Primary)

* Is there a secondary contact?

Please Select OneNoYes, at the same address as the primary contactYes, but at a different address than the primary contactIf there is a secondary contact, all emails and mailings will go to both contacts. In case of urgent need, the primary contact will be notified first

* First Name (Secondary)

* Last Name (Secondary)

* Email (Secondary)

* Phone (Secondary)

* Relationship to Student(s) (Secondary)

* Street Address (Secondary)

Street Address Line 2 (Secondary)

* City (Secondary)

* State (Secondary)

* ZIP (Secondary)

* Emergency Contact Name

* Emergency Contact Phone

* Emergency Contact Relationship

Section B: Student Enrollment Information

Student 1 Information

* Student 1 First Name

* Student 1 Last Name

* Student 1 Birthdate

* Student 1 Gender Identification

Please Select OneFemaleMaleNonbinary or Other

* Student 1 Hebrew Name

Student 1 Nickname (if applicable)

* Student 1 Grade in Religious School

* Student 1 Secular School Name

Student 1 Email (if applicable)

Information will not be shared publicly. Parents will be copied on all communication to students.

Student 1 Phone (if applicable)

Information will not be shared publicly. Students will not be contacted independently from parents.

* Student 1 Special Learning Needs

Please Select OneNoYes (IEP or 504 or similiar)If yes, Babette Cohn would like to meet with you before the school year begins to discuss the best ways to support your child. We invite you to send any documentation ahead of time to bcohn@shaaretefila.org

* Student 1 Allergies or Medications

Please Select OneNoYesDoes your child have allergies or medications we need to know about?

Student 1 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

Student 2 Information

* Student 2 First Name

* Student 2 Last Name

* Student 2 Birthdate

* Student 2 Gender Identification

Please Select OneFemaleMaleNonbinary or Other

* Student 2 Hebrew Name

Student 2 Nickname (if applicable)

* Student 2 Grade in Religious School

* Student 2 Secular School Name

Student 2 Email (if applicable)

Information will not be shared publicly. Parents will be copied on all communication to students.

Student 2 Phone (if applicable)

Information will not be shared publicly. Students will not be contacted independently from parents.

* Student 2 Special Learning Needs

* Student 2 Allergies or Medications

Please Select OneNoYesDoes your child have allergies or medications we need to know about?

Student 2 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

Student 3 Information

* Student 3 First Name

* Student 3 Last Name

* Student 3 Birthdate

* Student 3 Gender Identification

Please Select OneFemaleMaleNonbinary or Other

* Student 3 Hebrew Name

Student 3 Nickname (if applicable)

* Student 3 Grade in Religious School

* Student 3 Secular School Name

Student 3 Email (if applicable)

Information will not be shared publicly. Parents will be copied on all communication to students.

Student 3 Phone (if applicable)

Information will not be shared publicly. Students will not be contacted independently from parents.

* Student 3 Special Learning Needs

* Student 3 Allergies or Medications

Please Select OneNoYesDoes your child have allergies or medications we need to know about?

Student 3 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

Student 4 Information

* Student 4 First Name

* Student 4 Last Name

* Student 4 Birthdate

* Student 4 Gender Identification

Please Select OneFemaleMaleNonbinary or Other

* Student 4 Hebrew Name

Student 4 Nickname (if applicable)

* Student 4 Grade in Religious School

* Student 4 Secular School Name

Student 4 Email (if applicable)

Information will not be shared publicly. Parents will be copied on all communication to students.

Student 4 Phone (if applicable)

Information will not be shared publicly. Students will not be contacted independently from parents.

* Student 4 Special Learning Needs

* Student 4 Allergies or Medications

Please Select OneNoYesDoes your child have allergies or medications we need to know about?

Student 4 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

Section C: Release Forms

MEDICAL RELEASE: I HEREBY grant permission to Shaare Tefila Congregation to call a physician for necessary medical care or hospitalization for my child in case of an emergency, after attempting to notify me first. In case of injury (if I/we are not available), I/we the undersigned parent(s) or legal guardian(s) of my child, do hereby authorize the personnel of Shaare Tefila Congregation to administer necessary first aid and release the child to an emergency hospital or center for further treatment.

I give my child permission to attend any and all programs and field trips sponsored by Shaare Tefila's Chavaya Religious School during the 2022-23 school year. I understand and give permission for my child to be transported by bus, van, or car with staff and/or authorized parents. I hereby release Shaare Tefila, their employees, and any designated agents from any and all liability in the case of accident or injuries incurred while traveling to, or participating in, programs and events sponsored by the Youth Department both at the synagogue location and off-site. I understand that due caution and supervision will be provided at all times by Shaare Tefila, its employees and agents.

Health Insurance Company Name, Phone Number and Insurance ID Number

* Medical Release: Enter your name below

By typing my name, I confirm I have read, understand and agree to the above.

Learning Commitment

At Shaare Tefila we are committed to lifelong Jewish learning. Our program begins with our youngest learners (Pre-K Gan Katan and K) and extends to our teens through 12th grade. In order to become Bat/Bar Mitzvah at ST, we expect that students will attend a meaningful Jewish educational program. Attendance at Chavaya both before and after B'nai Mitzvah fulfills this requirement. We make exceptions for students who are enrolled in a Jewish day school, who cannot attend due to family relocation, or who provide evidence of a robust Jewish learning program that is equivalent to the Chavaya experience. If you have questions about this policy, contact Babette Cohn at bcohn@shaaretefila.org

* Learning Commitment: Enter your name below

By typing my name, I confirm I have read, understand and agree to the above.

Media Release

SHAARE TEFILA CHAVAYA & YOUTH DEPARTMENT MEDIA AUTHORIZATION: Many photos are taken during the school year, both in the Shaare Tefila building and during special events.

I authorize my child's photograph to be used in various Shaare Tefila publications, including, but not limited to, our synagogue website, social media sites, and other publicity materials. STUDENTS ARE NEVER IDENTIFIED BY NAME in any publicity.

* Media Release

Please Select OneI grant permission for my child's image to be usedI do not grant permission for my child’s image to be used

Section D: Congregation Community

You may have noticed that at the top of the form we begin with family information. This is intentional. The work of raising and educating Jewish children cannot be done in the school alone, but is a project of the school, the family and the community. You are not just registering your child(ren) for Chavaya today, but in fact your entire family. When you come in the building and spend time learning and volunteering with us, you make a powerful statement to your children that Jewish learning is a lifelong process and that we are all on the same team in creating these experiences for them. Don’t underestimate the subtle power of this statement!

We have several days during the course of the year (see calendar for dates) on which parents can participate in programs with students inside and outside of the shul. Please plan to join us on these days.

In addition to those opportunities to participate we are in need of regular volunteers to make our school work. Would you consider supporting our school in an ongoing role or a limited engagement?

Ongoing Opportunities (check all that apply)

Any other skills or talents you might be willing to share?

Section E: Payment Information

* Do you require financial aid?

Please Select OneNoYesThere are many impediments to Jewish education but finances should never be one. Should the need arise, we are happy to discuss financial aid options for synagogue members. If you select yes, you will discuss your payment ability in a confidential meeting with the Executive Director. If you have questions, contact Executive Director Briana Porter, bporter@shaaretefila.org

Total Amount