Post B’nai Mitzvah

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

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.

Name*

First Last Hebrew

Date of birth*

Gender*

Education information*

Please describe your child's learning style and provide any tips you have to help the teacher succeed in working with your child. We can 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. Please let us know this so that we can discuss with you which details, if any, it is appropriate to share with the teacher/leaders. Thanks!

Physician's Name*

Physician's Phone Number*

Allergies/Special Health Considerations*

Medication authorization

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*

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*

Health insurance company*

Insurance policy number*

Insurance company contact information*

Alternative Emergency Contact (Primary)

Name*

First Last

Address*

Street Address Address Line 2 City State ZIP Code

Phone (primary)*

Phone (secondary)*

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

Upper Valley
Jewish Community

Post B’nai Mitzvah