Thank you for registering your child for school at Oseh Shalom.

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Are you currently a member of Oseh Shalom?

YesNoNot SureInterested in Exploring

How Many Students are you registering?

Parent's information

First Name

Last Name

Email Address

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email Address

Address

City

State

Zip Code

County

Home Phone

Primary Contact Phone Number

Parent 2 Phone Contact Number

Is Parent 2 at the same address as Primary Contact?

YesNo

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

YesNo

Medical Insurance Company

Policy Number

Student's Doctor

Doctor's Phone Number

Emergency Medical Consent

YesNoI 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
YesNo

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

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

Rel Sch Registration

Thank you for registering your child for school at Oseh Shalom.

Are you currently a member of Oseh Shalom?

How Many Students are you registering?

Parent's information

First Name

Last Name

Email Address

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email Address

Address

City

State

Zip Code

County

Home Phone

Primary Contact Phone Number

Parent 2 Phone Contact Number

Is Parent 2 at the same address as Primary Contact?

Parent 2 Address

Parent 2 City

Parent 2 State

Parent 2 Zip Code

Parent 2 County

Medical Insurance

Medical Insurance Company

Policy Number

Student's Doctor

Doctor's Phone Number

Emergency Medical Consent

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 DirectoryYesNo

Is there any information you would like not to be included in the directory?

Photo Publishing Permission

Student First Name

Student Last Name

Student Hebrew Name

Student Email Address (for Madrichim only)

Who is Student Living With

Who is Student living with?

Student's Birth Date

Was the student born before or after sundown (used to calculate Hebrew Birthday)

Secular Grade in Fall 2024

Secular School in Fall 2024

Oseh Lower School Grade in Fall 2024

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

Doing Jewish-Confirmation (for all teens)

Doing Jewish-Confirmation (for all teens)

Madrichim Program (Teen Classroom Assistant)

Upper School Students Grade in Fall 2024

Emergency Information Above Applies to this Student

Changes to Medical Info for this Student

Allergies for this Student

Medications for this Student (if relevant)

Does your child receive services under a 504 plan, an IEP or other formal education plan?

Please Explain

Emergency Contact Information Above Applies to this Student

Emergency Contact Information

New Student? Please give us some more information about your child.

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?

Total

Consent to Appear in Religious School Family Directory
YesNo