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Oseh Shalom Religious School Student Registration
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Thank you for registering your child for school at Oseh Shalom.
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Are you currently a member of Oseh Shalom?
Yes
No
Not Sure
Interested in Exploring
*
How Many Students are you registering?
0
1
2
3
4
5
Parent's information
*
First Name
*
Last Name
*
Email Address
Parent 2 First Name
Parent 2 Last Name
Parent 2 Email Address
Address
City
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
County
Home Phone
Primary Contact Phone Number
Parent 2 Phone Contact Number
Is Parent 2 at the same address as Primary Contact?
Yes
No
Parent 2 Address
Parent 2 City
Parent 2 State
Parent 2 Zip Code
Parent 2 County
Emergency Medical Information for my Children
(If children have different info, that can be captured for each child in the next section.)
Medical Insurance
Yes
No
Medical Insurance Company
Policy Number
Student's Doctor
Doctor's Phone Number
Emergency Medical Consent
Yes
No
I hereby give consent for (1) administration of emergency medical treatment, and (2) the transfer of my child to a nearby hospital. Facts concerning my child's medical history including allergies, medications being taken and physical impairment to which a medical specialist should be alerted are listed below.
Emergency Contact Information
Name of Emergency Contact #1>
Phone of Emergency Contact #1>
Email of Emergency Contact #1>
Relationship to Student>
Name of Emergency Contact #2>
Phone of Emergency Contact #2>
Email of Emergency Contact #2>
Relationship to Student>
Student Information
Consent to Appear in Religious School Family Directory
Yes
No
Is there any information you would like not to be included in the directory?
Photo Publishing Permission
Yes, I give permission for my child’s photo to be used in the Oseh newsletter, the Oseh website, etc.
No, I understand that in order to opt out I will need to email the Director at EducationDirector@oseh-shalom.org
Student Information
*
Student First Name
*
Student Last Name
Student Hebrew Name
Student Email Address (for Madrichim only)
Who is Student Living With
Both
Parent 1
Parent 2
Other
Who is Student living with?
i.e. grandmother
*
Student's Birth Date
Was the student born before or after sundown (used to calculate Hebrew Birthday)
Before Sundown
After Sundown
*
Secular Grade in Fall 2024
Secular School in Fall 2024
Oseh Lower School Grade in Fall 2024
Does Not Apply
Prekindergarten (starts at age 3)
Kindergarten
First Grade (1st)
Second Grade (2nd)
Third Grade (3rd)
Fourth Grade (4th)
Fifth Grade (5th)
Sixth Grade (6th)
Seventh (B'nei Mitzvah Prep)
Oseh Upper School Check all that Apply: Note- 8-12 Graders May Choose up to Three options. (Teen programming meets on alternate days/times)
TeenConnect
TeenConnect
Focus - Social Connection, Tzedakah, Art, Israel, Synagogue Projects, Student Leadership and More.
Meets 1st, 3rd and 5th Sundays 10:45 - 11:30am
Doing Jewish-Confirmation (for all teens)
Doing Jewish-Confirmation (for all teens)
Focus -Experiencing Judaism, Jewish History, Modern Hebrew Conversation, Torah, Jewish Values and More.
Meets 2nd and 4th Sundays 10:45 - 11:30am
Madrichim Program (Teen Classroom Assistant)
No, Thanks.
Volunteer Madrich/Madrichah (Grades 8-12 and must be enrolled in TeenConnect and/or Doing Jewish)
Paid Madrich/Madrichah (Grades 9-12 and must be enrolled in TeenConnect and/or Doing Jewish)
Upper School Students Grade in Fall 2024
Does Not Apply
Eighth Grade (8th)
Ninth Grade (9th)
Tenth Grade (10th)
Eleventh (11th)
Twelfth Grade (12th)
Additional Emergency Medical Information
Emergency Information Above Applies to this Student
Yes
No
Changes to Medical Info for this Student
Please indicate Changes to Insurance and/or Doctors,
Allergies for this Student
Medications for this Student (if relevant)
Special Services Information/Education Plan
Does your child receive services under a 504 plan, an IEP or other formal education plan?
No
504
IEP
Other
Please Explain
Additional Emergency Contact Information
Emergency Contact Information Above Applies to this Student
Yes
No
Emergency Contact Information
Please include Emergency Contact Name(s), Phone, Relationship to child and email addresses
New Student? Please give us some more information about your child.
Yes - New Student
No - Returning Student
Tell us about your child's strengths:
What are your expectations for the coming religious school year?
How can we best address your child's needs?
What else would you like to share about your child?
Next Student
I understand a $150 family deposit is due before or on June 30th in order to receive the early bird discount.
I understand a $150 family deposit is due before or on June 30th in order to receive the early bird discount.
*
Yes, I understand that attendance at family programs and family services is an integral part of my child/children's education
Yes, I understand that attendance at family programs and family services is an integral part of my child/children's education
Total
Thu, August 22 2024 18 Av 5784