2023-2024 Religious School Registration - Form

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* Is your family new to our school?

Please Select OneNoYes

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

Check this box if you require financial aid.

Check this box if you require financial aid.There can sometimes be obstacles to Jewish education but finances should never be one! We ask that every family commits to some financial contribution, however we are very happy to discuss financial aid options for any family who needs it. If you select yes, you will discuss your payment ability in a confidential meeting with Missy Lowdermilk.

Student 1 Information

* Student 1 First Name

* Student 1 Last Name

* Student 1 Birthdate

* Student 1 Hebrew Name

Student 1 Nickname (if applicable)

* Student 1 Grade in Religious School

This is the same as your child's grade for the coming secular school year unless you have made other arrangements with the religious school office.

* 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)Yes (no clinical label or formal plan in place yet)If yes, Rabbi Miller would love to meet with you and your child’s teacher before the school year begins so that we are able to discuss the best ways to support your child from the outset. If you are comfortable doing so, we invite you to send any documentation ahead of time to school@ohev.net.

* 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.

What else would you like Rabbi Miller and your child's teacher to know about your child?

Feel free to share any special interests, talents, struggles, aversions, or pieces of relevant personal history that you feel might be relevant and that you ae comfortable sharing.

Student 2 Information

* Student 2 First Name

* Student 2 Last Name

* Student 2 Birthdate

* Student 2 Hebrew Name

Student 2 Nickname (if applicable)

* Student 2 Grade in Religious School

This is the same as your child's grade for the coming secular school year unless you have made other arrangements with the religious school office.

* 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

Please Select OneNoYes (IEP or 504)Yes (no clinical label or formal plan in place yet)If yes, Rabbi Miller would love to sit down with you and your child’s teacher before the school year begins so that we are able to discuss the best ways to support your child from the outset. If you are comfortable doing so, we invite you to send any documentation ahead of time to school@ohev.net.

* 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.

What else would you like Rabbi Miller and your child's teacher to know about your child?

Feel free to share any special interests, talents, struggles, aversions, or pieces of relevant personal history that you feel might be relevant and that you ae comfortable sharing

Student 3 Information

* Student 3 First Name

* Student 3 Last Name

* Student 3 Birthdate

* Student 3 Hebrew Name

Student 3 Nickname (if applicable)

* Student 3 Grade in Religious School

This is the same as your child's grade for the coming secular school year unless you have made other arrangements with the religious school office.

* Student 3 Grade in Religious School

This is the same as your child's grade for the coming secular school year unless you have made other arrangements with the religious school office.

* 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

Please Select OneNoYes (IEP or 504)Yes (no clinical label or formal plan in place yet)If yes, Rabbi Miller would love to sit down with you and your child’s teacher before the school year begins so that we are able to discuss the best ways to support your child from the outset. If you are comfortable we invite you to send any documentation ahead of time to school@ohev.net.

* 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.

What else would you like Rabbi Miller and your child's teacher to know about your child?

Feel free to share any special interests, talents, struggles, aversions, or pieces of relevant personal history that you feel might be relevant and that you ae comfortable sharing

Student 4 Information

* Student 4 First Name

* Student 4 Last Name

* Student 4 Birthdate

* Student 4 Hebrew Name

Student 4 Nickname (if applicable)

* Student 4 Grade in Religious School

This is the same as your child's grade for the coming secular school year unless you have made other arrangements with the religious school office.

* 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

Please Select OneNoYes (IEP or 504)Yes (no clinical label or formal plan in place yet)If yes, Rabbi Miller would love to sit down with you and your child’s teacher before the school year begins so that we are able to discuss the best ways to support your child from the outset. If you are comfortable we invite you to send any documentation ahead of time to school@ohev.net

* 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.

What else would you like Rabbi Miller and your child's teacher to know about your child?

Feel free to share any special interests, talents, struggles, aversions, or pieces of relevant personal history that you feel might be relevant and that you ae comfortable sharing

Section C: Release Forms

By signing my name below, my child(ren) have permission to participate in the Mispallelim religious school of Congregation Ohev Shalom in Wallngford, PA. I hereby authorize the Education Director, or person designated by the Education Director, to obtain emergency medical care for my child(ren) in the event such care is indicated. I give my permission for my child(ren) to receive emergency medical care by any nurse, doctor, paramedic or member of a medical staff of a hospital licensed by the Commonwealth of Pennsylvania. I understand that every effort will be made to notify a parent/guardian prior to treatment.

I certify that my child(ren) is(are) in good physical health. They have my permission to participate in all activities that are part of the regular religious school program. Field trips may be arranged by Congregation Ohev Shalom, and transportation may include bus or vehicle driven by a classmate's parent or guardian.

* Medical Release: Enter your name below

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

Media Release

From time to time your child’s photo may be taken in our classrooms or special events. We use these photos on the synagogue website, on our synagogue display boards, in the weekly Mispallelim email as well as private Facebook groups and other publicity materials.

* I give my permission for my child(ren)'s photo to be used:

Please Select OneOn any materialsOn specific materials with my permissionI do not give my permission for my child’s image to be used

Section D: Congregation Community

The work of building a powerful Jewish experience for our students is only possible with the help of family support and, from time to time, volunteers for specific programs or projects. Beyond the logistical help, it is so powerful for our students to see the adults in their lives modeling engagement with Jewish communal life.

Below, you will have an opportunity to share some ways in which you would like to be involved as a parent volunteer and community member.

Event Volunteer opportunities (check all that apply)

If other, what would you like to share?

Section E: Payment Information

In Jewish tradition, it is the job not only of parents but of the community to provide education for children. The Ohev Shalom community is committed to this obligation. As such, our religious school fee only covers a portion of the cost of our religious school. Both fundraising efforts and congregational dues heavily subsidize our children’s education. We are best able to plan appropriately when we know early on how many students to expect in each grade. In order to ensure that we have accurate numbers, we do require families to register on or before July 31st. A late registration fee is charged for those returning students who are registered on or after August 1st.

Fee Structure:

Grade	Timing	Regular Fee	Fee after Agust 1st
Early Learning	Every Sunday 9:00-10:30	$300	$350
K-2	Sundays 9:00-12:15	$850	$900
3-7	Sundays 9:00-12:15 Wednesdays 4:15-6:15	$1015	$1065

► You have requested financial assistance. Check the box below, then please contact Missy Lowdermilk (exec@ohev.net) to set up your meeting as soon as possible.

Financial Aid Follow-up: I understand and will contact Missy Lowdermilk

Late Fee Added

Late fee of $50 added

Total Amount