Hebrew School Registration Form

Thank you for registering your children in our Hebrew school. We look forward to seeing them in the fall.

In order to enroll your children in the UVJC religious school, you must be a member in good standing at the UVJC. Please do not hesitate to contact our treasurer at treasurer@uvjc.org for special abatements or scholarships if you are in financial need. The UVJC does not turn anyone away for financial reasons.

*

I accept the policy that I must join the UVJC or renew my membership this year in order to enroll my children in Hebrew school.

First (Eldest) Child's Information

Name (Child 1)*

First Last Hebrew

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. We are able to develop a more positive learning environment for your child when we know, in advance, if s/he has an IEP or 504 plan in regular school. We would like to discuss with you which details, if any, it is appropriate to share with the classroom teacher. Thanks!

Personal information (Child 1)

Please describe one thing your child likes (e.g., karate, acting, strawberries, Harry Potter, etc.)

Physician's Name (Child 1)*

Physician's Phone Number*

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*

Would you like to register a second child?*

Yes
No

Second Child's Information

Second Child's Name

First Last Hebrew

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. We are able to develop a more positive learning environment for your child when we know, in advance, if s/he has an IEP or 504 plan in regular school. We would like to discuss with you which details, if any, it is appropriate to share with the classroom teacher. Thanks!

Personal information (Child 2)

Please describe one thing your child likes (e.g., karate, acting, strawberries, Harry Potter, etc.)

Physician's Name (Child 2)

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*

Would you like to register a third child?

Yes
No

Third Child's Information

Name (Child 3)

First Last Hebrew

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. We are able to develop a more positive learning environment for your child when we know, in advance, if s/he has an IEP or 504 plan in regular school. We would like to discuss with you which details, if any, it is appropriate to share with the classroom teacher. Thanks!

Personal information (Child 3)

Please describe one thing your child likes (e.g., karate, acting, strawberries, Harry Potter, etc.)

Physician's Name (Child 3)

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*

Would you like to register a fourth child?

Yes
No

Fourth Child's Information

Name (Child 4)

First Last Hebrew

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. We are able to develop a more positive learning environment for your child when we know, in advance, if s/he has an IEP or 504 plan in regular school. We would like to discuss with you which details, if any, it is appropriate to share with the classroom teacher. Thanks!

Personal information (Child 4)

Please describe one thing your child likes (e.g., karate, acting, strawberries, Harry Potter, etc.)

Physician's Name (Child 4)

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*

Parent/Guardian 1 Information

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone (primary)*

Phone (secondary)*

Email*

Parent/Guardian 2 Information

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:

Health insurance company*

Insurance policy number*

Insurance company contact information*

Alternative Emergency Contact (Primary)

Name*

First Last

Address*

City State

Phone (primary)*

Phone (secondary)*

Alternative Emergency Contact (Secondary)

Name*

First Last

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

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