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.

Subject to health conditions, the 5783 (22-23) school year will be from 10 am to noon for all grades on Sundays, and from 4 to 5:30 pm on Tuesdays for grades 4-7. Everybody (faculty, students, parents) must be fully vaccinated to attend in person and there may be times when we require masks and only eat food outdoors. There is no online option planned this year.

School will start on September 18th and the last day will be May 21st.

Families who register and pay or arrange to pay in full before July 1st will receive a discount of $36 per family.

Agreements*

Select All
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 my FAMILY'S MEMBERSHIP must either paid in full for the current year or have established an automatic debit payment plan for the year, and that the account must be up to date for prior years 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)*

Gender (Child 1)*

Grade level (Child 1)*

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.

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)

Gender (Child 2)

Grade level (Child 2)

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.

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)

Gender (Child 3)

Grade level (Child 3)

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.

Tuition (Child 3)

Registration fee (Child 3) $18

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)

Gender (Child 4)

Grade level (Child 4)

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.

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

Early bird discount

Families who register and pay (or arrange a direct debit plan) prior to July 1 will receive a discount of $36.

Early bird registration (before July 1) -$36 per family
Regular registration

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:

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