Today is January 27, 2022 /

Hebrew School Registration Form

We are delighted that you are registering your children in our Hebrew school. Every student's family must be a member, in good standing, of the synagogue. Please do not hesitate to contact our treasurer at treasurer@uvjc.org for assistance if you have financial need. Kol Ha'Emek does not turn anyone away for financial reasons.
Our community values Jewish education for every child. We look forward to helping you support your children's Jewish development.

For 5782 School year, we will be in person at the Roth Center for all grades. When the weather is reasonable, we will hold classes outdoors. When it gets too cold, we will reassess based on community health conditions. Everybody (faculty, students, parents) will wear a mask inside the Roth Center, regardless of vaccination status.

Judaic Studies classes:
Kitah Koof, Aleph, and Bet (PK-2nd grade) will meet on Sundays from 9 to 10:20 am. That includes 20 minutes of assembly aimed at this age group, followed by 1 hour of class time.

Kitah Gimel, Dalet, Hay, and Zayin will meet on Sundays from 10:30 to noon. That includes 20 minutes of assembly aimed at this age group, followed by 70 minutes of class time. They will also meet on Tuesdays from 4-5 pm.

Hebrew instruction: Based on last year’s success with this model, we will continue to teach Hebrew to students 1:1. Each student will have 10 or 15 minutes per week with a teacher at a time you choose from a list of options. Some of the options will be right before or after school on Sundays or Tuesdays, some will be on Zoom at a mutually convenient time.

School will start on September 19th, after the high holidays. That is actually the day before Erev Sukkot so we will be putting up our brand new sukkah! See the attached fall term calendar for other dates of interest.
Agreements*
- I accept the policy that my children’s tuition and registration fees must be paid in full, or the family must have established an automatic debit payment plan, in order to attend Hebrew School classes and associated activities.
*
- I accept the policy that our family's membership dues must be paid in full, or the family must have established an automatic debit payment plan, in order to attend Hebrew School classes and associated activities.
First (Eldest) Child's Information
Name (Child 1)*
First Last Hebrew
Email (Child 1)*

Please provide the email that you would like to use for your child to participate in online Hebrew learning activities. We will subscribe this email to the ShalomLearning online learning platform for homework.
Date of birth (Child 1)*
MM slash DD slash YYYY
Gender (Child 1)*
Grade level (Child 1)*
- Pre-K / K
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
Education information (Child 1)*
Please describe your child's learning style and provide any tips you have to help the teacher succeed in working with your child.
Special education information (Child 1)*
Does your child have an IEP or 504 plan in regular school? We are able to develop a more positive learning environment for each child when we know about it in advance. If your child has one, we hope you feel comfortable sharing which details, if any, are appropriate for our classroom teacher to know. Thanks!
- This child has no IEP or 504 plan
- This child has an IEP/504 plan and we feel comfortable emailing it to the education director
- This child has an IEP/504 plan and we are willing to email the education director selected strategies from it that the Hebrew School teachers can use in working with the child.
Personal information (Child 1)*
Please describe one thing your child likes (e.g., karate, acting, strawberries, Harry Potter, etc.)
Allergies, food restrictions, other health considerations, and medications that might need to be administered at Hebrew School (Child 1)*
Medication authorization (Child 1)
- I authorize the UVJC to administer medications that I have supplied for medical conditions noted above. I have supplied the following medications to the Director of Education, and instructions are attached to the medications supplied.
For children in grades 1-7, what is your FIRST CHOICE for Hebrew 1:1 timing (Child 1)?*
Which slot is best for child 1? We can't guarantee you'll get what you want, but we'll do our best.
For children in grades 1-7, what is your SECOND CHOICE for Hebrew 1:1 timing (Child 1)?*
In case everyone has the same preferences, which alternative slot is your second choice for child 1?
Tuition (Child 1)*
Registration fee (Child 1) $18*
Would you like to register a second child?*
- Yes
- No
Second Child's Information
Second Child's Name
First Last Hebrew
Email (Child 2)

Please provide the email that you would like to use for your child to participate in online Hebrew learning activities. We will subscribe this email to the ShalomLearning online learning platform for homework.
Date of birth (Child 2)
MM slash DD slash YYYY
Gender (Child 2)
Grade level (Child 2)
- Pre-K / K
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
Education information (Child 2)
Please describe your child's learning style and provide any tips you have to help the teacher succeed in working with your child.
Special education information (Child 2)
Does your child have an IEP or 504 plan in regular school? We are able to develop a more positive learning environment for each child when we know, in advance. If your child has one, we would we would like to discuss with you which details, if any, it is appropriate to share with the classroom teacher. Thanks!
- This child has no IEP or 504 plan
- This child has an IEP/504 plan and we will email it to the education director
- This child has an IEP/504 plan and we email the education director some strategies from it that the Hebrew School teachers can use in working with the child.
Personal information (Child 2)
Please describe one thing your child likes (e.g., karate, acting, strawberries, Harry Potter, etc.)
Allergies, food restrictions, other health considerations, and medications that might need to be administered at Hebrew School (Child 2)
Medication authorization (Child 2)
- I authorize the UVJC to administer medications that I have supplied for medical conditions noted above. I have supplied the following medications to the Director of Education, and instructions are attached to the medications supplied.
For children in grades 1-7, what is your FIRST CHOICE for Hebrew 1:1 timing (Child 2)?*
Which slot is best for child 2? We can't guarantee you'll get what you want, but we'll do our best.
For children in grades 1-7, what is your SECOND CHOICE for Hebrew 1:1 timing (Child 2)?*
Which slot is your second choice for child 2?
Tuition (Child 2)
Registration fee (Child 2) $18
Would you like to register a third child?
- Yes
- No
Third Child's Information
Name (Child 3)
First Last Hebrew
Email (Child 3)

Please provide the email that you would like to use for your child to participate in online Hebrew learning activities. We will subscribe this email to the ShalomLearning online learning platform for homework.
Date of Birth (Child 3)
MM slash DD slash YYYY
Gender (Child 3)
Grade level (Child 3)
- Pre-K / K
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
Education information (Child 3)
Please describe your child's learning style and provide any tips you have to help the teacher succeed in working with your child.
Special education information (Child 3)
Does your child have an IEP or 504 plan in regular school? We are able to develop a more positive learning environment for each child when we know, in advance. If your child has one, we would we would like to discuss with you which details, if any, it is appropriate to share with the classroom teacher. Thanks!
- This child has no IEP or 504 plan
- This child has an IEP/504 plan and we will email it to the education director
- This child has an IEP/504 plan and we email the education director some strategies from it that the Hebrew School teachers can use in working with the child.
Personal information (Child 3)
Please describe one thing your child likes (e.g., karate, acting, strawberries, Harry Potter, etc.)
Allergies, food restrictions, other health considerations, and medications that might need to be administered at Hebrew School (Child 3)
Medication authorization (Child 3)
- I authorize the UVJC to administer medications that I have supplied for medical conditions noted above. I have supplied the following medications to the Director of Education, and instructions are attached to the medications supplied.
For children in grades 1-7, what is your FIRST CHOICE for Hebrew 1:1 timing (Child 3)?*
Which slot is best for child 3? We can't guarantee you'll get what you want, but we'll do our best.
For children in grades 1-7, what is your SECOND CHOICE for Hebrew 1:1 timing (Child 3)?*
Which slot is your second choice for child 3?
Tuition (Child 3) $18
Registration fee (Child 3)
Would you like to register a fourth child?
- Yes
- No
Fourth Child's Information
Name (Child 4)
First Last Hebrew
Email (Child 4)

Please provide the email that you would like to use for your child to participate in online Hebrew learning activities. We will subscribe this email to the ShalomLearning online learning platform for homework.
Date of Birth (Child 4)
MM slash DD slash YYYY
Gender (Child 4)
Grade level (Child 4)
- Pre-K / K
- 1
- 2
- 3
- 4
- 5
- 6
- 7
- 8
Education information (Child 4)
Please describe your child's learning style and provide any tips you have to help the teacher succeed in working with your child.
Special education information (Child 4)
Does your child have an IEP or 504 plan in regular school? We are able to develop a more positive learning environment for each child when we know, in advance. If your child has one, we would we would like to discuss with you which details, if any, it is appropriate to share with the classroom teacher. Thanks!
- This child has no IEP or 504 plan
- This child has an IEP/504 plan and we will email it to the education director
- This child has an IEP/504 plan and we email the education director some strategies from it that the Hebrew School teachers can use in working with the child.
Personal information (Child 4)
Please describe one thing your child likes (e.g., karate, acting, strawberries, Harry Potter, etc.)
Allergies, food restrictions, other health considerations, and medications that might need to be administered at Hebrew School (Child 4)
Medication authorization (Child 4)
- I authorize the UVJC to administer medications that I have supplied for medical conditions noted above. I have supplied the following medications to the Director of Education, and instructions are attached to the medications supplied.
For children in grades 1-7, what is your FIRST CHOICE for Hebrew 1:1 timing (Child 4)?*
Which slot is best for child 4? We can't guarantee you'll get what you want, but we'll do our best.
For children in grades 1-7, what is your SECOND CHOICE for Hebrew 1:1 timing (Child 4)?*
Which slot is your second choice for child 4?
Tuition (Child 4)
Registration fee (Child 4) $18
Newcomers in Grade 5 or above
In order to cover the cost of one-on-one tutoring for newcomers who have limited Hebrew and/or Judaic knowledge, we charge a supplementary fee to these students.
Supplement for newcomers in Grade 5 and above*
We provide extra tutoring to students who begin studying Hebrew or Judaism in grade 5 or 6 so that they will be on track to become b'mitzvot with their classmates. This requires an extra commitment of time and resources on our part, and so we charge a supplemental fee to defray the cost.
- Newcomers in Grade 5 ($180)
- Newcomers in Grade 6 ($250) or above
- We enrolled prior to Grade 5
Parent/Guardian 1 Information
Please include information for all custodial parents.
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone (primary)*
Phone (secondary)
Email*
Parent/Guardian 2 Information
Please include information for all custodial parents. We prefer to keep all parents in the loop even if one takes primary responsibility for the children's Jewish education.
Name*
First Last
Address*
Street Address Address Line 2 City State ZIP Code
Phone (primary)*
Phone (secondary)
Email*
Photo Authorization*
Please indicate below whether you give permission for your children’s first name(s) and/or photograph(s) or video(s) to be used on the UVJC website, in school newsletters, in congregational newsletters, and on weekly email updates.
Mitzvah opportunities*
Please check the mitzvot you would like to undertake this year, assuming that COVID health concerns allow for such activities:
- Select All
- sanitize tables and chairs between classes
- host the families in my child's class for a pot-luck havurah (1-2 hour shabbat or havdallah meal / candle lighting / social gathering)
- greet people and let them into the Roth Center during Hebrew school
- drive students in my child's class on a local field trip (typically nursing home or food pantry)
- substitute teach in a K-2 classroom (lesson plans provided, Hebrew skills not required!)
- tutor a student on the aleph bet one-on-one once a week for 10 minutes (on Zoom or in person at Roth)
- host a Dartmouth Hillel student for shabbat or a holiday meal
- make latkes (at the Roth Center) for Hannukah
- bake treats for Purim
- lead a workshop or activity at the Congregational Retreat at Hulbert
- set out snack and juice for kiddish on Sunday mornings
- other: please email school@uvjc.org because Melissa can't figure out how to add a text box here
Alternative Emergency Contact (Primary)
Name*
First Last
Relationship to your child*
Address*
City State
Phone (primary)*
Phone (secondary)
Alternative Emergency Contact (Secondary)
Name*
First Last
Relationship to your child*
Address*
City State
Phone (primary)*
Phone (secondary)
Vaccination record
In accordance with the Kol Ha'Emek vaccination policy, please upload a copy of each child's vaccination record. The records will be reviewed by a licensed medical professional and stored securely.
Drop files here or

Accepted file types: pdf, jpg, doc, Max. file size: 32 MB.
Payment Information
You will be sent an invoice via email. Please direct any questions to Chris DePierro by email at office@uvjc.org or by phone at (603) 646-0460.
Total
$0.00

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Upper Valley Jewish Community
5 Occom Ridge, Hanover, NH 03755
603-646-0460 | office@uvjc.org

Hebrew School Registration Form

Hebrew School Registration Form

First (Eldest) Child's Information

Second Child's Information

Third Child's Information

Fourth Child's Information

Newcomers in Grade 5 or above

Parent/Guardian 1 Information

Parent/Guardian 2 Information

Alternative Emergency Contact (Primary)

Alternative Emergency Contact (Secondary)

Payment Information