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School Registration 17/18

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Parent 1 First Name(*)
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Parent 1 Last Name(*)
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Parent 2 First Name
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Parent 2 Last Name
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Do both parents live at the same address?
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Are you a new member at Am Shalom (joined since February, 2017)?(*)

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How many children are you registering for school at Am Shalom?(*)
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Sunday School is for Kindergarten through 10th grade, Hebrew School is for 2nd through 6th Grade. Our pre-K class, which meets once a month, is currently full - please contact our office to join the wait list.

Do you have an eleventh and/or twelfth grader that would be interested in our post-confirmation program?(*)
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It is not required to have participated in the confirmation program to participate in post-confirmation. Our post confirmation program meets once a month, and will also have a scheduled trip this year.

How many 11 and 12th graders do you have that are interested in our post confirmation program?
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Street Address(*)
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City(*)
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State(*)
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Zip Code(*)
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E-mail Address(*)
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Home Phone Number(*)
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Cell Phone Number(*)
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Work Phone Number
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2nd Parent
Please select one of the following regarding communication with second parent

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Street Address
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City
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State
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Zip Code
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Home Phone Number
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Parent 2 E-mail Address
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Parent 2 Work Phone Number
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Parent 2 Cell Phone Number
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1st Child
Child 1 First Name(*)
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Child 1 Last Name(*)
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Nickname
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Gender(*)
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Birth Date(*)
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Child E-mail Address
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Child Cell Phone Number
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T-Shirt Size(*)
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Grade Level in 2017/2018(*)
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Name of Public or day school(*)
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If your child attends a summer camp, please tell us which one:
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Does this child have any allergies and/or intolerances?

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Please check all that apply

Please list any other allergies and/or intolerances here
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Does this child carry an Epipen?(*)
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Will they attend Wednesday Hebrew School?(*)
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Hebrew School is for 2nd - 6th Graders on Wednesdays

Who is your child's Hebrew tutor?
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If you do not have one yet, please let us know. It is important that if your child is not participating in Hebrew School that they have tutoring to keep them prepared.

What kinds of activities does your child like to participate in?

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Please check all that apply

Does your child have an IEP?(*)
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Does your child have any specific learning or behavioral challenges that we should be aware of so that we may provide the most effective experiences in our programs? If so, please describe below in as much detail as needed:
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Please tell us a little bit more about your child: What does your child like? What are their interests? Talents? What can you tell us about them personally that can best help us improve their classroom experience? All information is appreciated. Please do not put friendship or teacher requests here; there will be an opportunity for those below.
(*)
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Which class would I like my child placed in?
•Class placement is done with the child's best interest in mind.
•Requests for TWO Religious School classmates may be submitted, and for one teacher.
•We cannot guarantee requests after July 30.
•Hebrew placements are made by the educational staff based on assessments and teacher recommendations.
•While we will try our best to honor requests, we cannot guarantee that all requests will be honored. Our goal is to provide the most inclusive and best atmosphere for all of our students, and therefore, requests may sometimes not be honored. We will try our best to honor the friendship OR the teacher request. •If you don't know who the teachers are, don't worry! We will use the information that you have given us in this form to choose the best teacher for your child. Please make sure you have filled in this form as fully as possible.
Child 1 First Friendship Request:
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Child 1 Second Friendship Request
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Child 1 Teacher Request
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If you could only have one, which request is more important to you?
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2nd Child
Child 2 First Name(*)
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Child 2 Last Name(*)
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Nickname
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Gender(*)
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Birth Date(*)
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Child E-mail Address
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Child Cell Phone Number
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T-Shirt Size(*)
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Grade Level in 2017/2018(*)
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Name of Public or day school(*)
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If your child attends a summer camp, please tell us which one:
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Does this child have any allergies and/or intolerances?

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Please check all that apply

Please list any other allergies and/or intolerances here
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Does this child carry an Epipen?(*)
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Will they attend Wednesday Hebrew School?(*)
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Hebrew School is for 2nd - 6th Graders on Wednesdays

Who is your child's Hebrew tutor?
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If you do not have one yet, please let us know. It is important that if your child is not participating in Hebrew School that they have tutoring to keep them prepared.

What kinds of activities does your child like to participate in?

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Please check all that apply

Does your child have an IEP?(*)
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Does your child have any specific learning or behavioral challenges that we should be aware of so that we may provide the most effective experiences in our programs? If so, please describe below in as much detail as needed:
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Please tell us a little bit more about your child: What does your child like? What are their interests? Talents? What can you tell us about them personally that can best help us improve their classroom experience? All information is appreciated. Please do not put friendship or teacher requests here; there will be an opportunity for those below.
(*)
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Which class would I like my child placed in?
•Class placement is done with the child's best interest in mind.
•Requests for TWO Religious School classmates may be submitted, and for one teacher.
•We cannot guarantee requests received after July 30.
•Hebrew placements are made by the educational staff based on assessments and teacher recommendations.
•While we will try our best to honor requests, we cannot guarantee that all requests will be honored. Our goal is to provide the most inclusive and best atmosphere for all of our students, and therefore, requests may sometimes not be honored. •If you don't know who the teachers are, don't worry! We will use the information that you have given us in this form to choose the best teacher for your child. Please make sure you have filled in this form as fully as possible.
Child 2 First Friendship Request:
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Child 2 Second Friendship Request
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Child 2 Teacher Request
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If you could only have one, which request is more important to you?
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3rd Child
Child 3 First Name(*)
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Child 3 Last Name(*)
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Nickname
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Gender(*)
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Birth Date(*)
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Child E-mail Address
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Child Cell Phone Number
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T-Shirt Size(*)
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Grade Level in 2017/2018(*)
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Name of Public or day school(*)
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If your child attends a summer camp, please tell us which one:
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Does this child have any allergies and/or intolerances?

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Please check all that apply

Please list any other allergies and/or intolerances here
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Does this child carry an Epipen?(*)
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Will they attend Wednesday Hebrew School?(*)
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Hebrew School is for 2nd - 6th Graders on Wednesdays

Who is your child's Hebrew tutor?
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If you do not have one yet, please let us know. It is important that if your child is not participating in Hebrew School that they have tutoring to keep them prepared.

What kinds of activities does your child like to participate in?

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Please check all that apply

Does your child have an IEP?(*)
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Does your child have any specific learning or behavioral challenges that we should be aware of so that we may provide the most effective experiences in our programs? If so, please describe below in as much detail as needed:
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Please tell us a little bit more about your child: What does your child like? What are their interests? Talents? What can you tell us about them personally that can best help us improve their classroom experience? All information is appreciated. Please do not put friendship or teacher requests here; there will be an opportunity for those below.
(*)
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Which class would I like my child placed in?
Child 3 First Friendship Request:
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Child 3 Second Friendship Request
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Child 3 Teacher Request
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If you could only have one, which request is more important to you?
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4th Child
Child 4 First Name(*)
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Child 4 Last Name(*)
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Nickname
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Gender(*)
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Birth Date(*)
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Child E-mail Address
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Child Cell Phone Number
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T-Shirt Size(*)
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Grade Level in 2017/2018(*)
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Name of Public or day school(*)
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If your child attends a summer camp, please tell us which one:
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Does this child have any allergies and/or intolerances?

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Please check all that apply

Please list any other allergies and/or intolerances here
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Does this child carry an Epipen?(*)
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Will they attend Wednesday Hebrew School?(*)
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Hebrew School is for 2nd - 6th Graders on Wednesdays

Who is your child's Hebrew tutor?
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If you do not have one yet, please let us know. It is important that if your child is not participating in Hebrew School that they have tutoring to keep them prepared.

What kinds of activities does your child like to participate in?

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Please check all that apply

Does your child have an IEP?(*)
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Does your child have any specific learning or behavioral challenges that we should be aware of so that we may provide the most effective experiences in our programs? If so, please describe below in as much detail as needed:
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Please tell us a little bit more about your child: What does your child like? What are their interests? Talents? What can you tell us about them personally that can best help us improve their classroom experience? All information is appreciated. Please do not put friendship or teacher requests here; there will be an opportunity for those below.
(*)
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Which class would I like my child placed in?
Child 4 First Friendship Request:
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Child 4 Second Friendship Request
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Child 4 Teacher Request
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If you could only have one, which request is more important to you?
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7th Grade
This year, our 7th Graders will have the option to pick between four different options, that occur during different times of the week. Each option will be capped at 15 total students. Please read more about each option below, and then rank your top 3 different choices for this year.
Madrichim-in-Training - Sundays 9:15-11:30am: Madrichim are the helpers in our religious school classrooms. Our 7th Grade Madrichim will have several required additional training sessions before or after Religious School, scheduled in advance, and one session that will take place before the Religious School Year begins.

Advanced Hebrew School - Wednesdays 4:15-6:00pm: 7th grade Advanced Hebrew School will focus on Modern Hebrew, in addition to training our 7th graders to be helpers in our Hebrew School. Also, this will help prepare students who plan to take Hebrew in high school.

Jewish Culture Study - Sundays 11:30am-1:00pm: Students will learn about Judaism through cultural study, such as cooking, arts, music, and drama. (This group will also have bagel brunch with the 8-10th graders on Sunday mornings)

Philanthropy & Tikkun Olam (Repair the World) - Mondays 6:15-7:30pm: Through thought-provoking discussion and learning, these students will learn about philanthropy and major world issues. Students will engage in a tikkun olam (repair the world) project together as a group.

Please rank your top 3 DIFFERENT choices below:
First 7th Grader Name:(*)
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First Choice for 7th Grade:(*)
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Second Choice for 7th Grade:(*)
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Third Choice for 7th Grade:(*)
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Second 7th Grader Name(*)
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First Choice for 7th Grade:(*)
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Second Choice for 7th Grade:(*)
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Third Choice for 7th Grade:(*)
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7th Grade Additional Comments:
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11th and 12th graders
1st 11th/12th Grader
What is your eleventh and/or twelfth graders name?(*)
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What grade is your 11/12th grader in?
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What is your 11th and 12th graders e-mail?(*)
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What is your 11/12 grader's phone number?
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2nd 11th/12th Grader
What is your second eleventh and/or twelfth graders name?(*)
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What grade is your second 11/12th grader in?
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What is your second 11th and 12th graders e-mail?(*)
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What is your 11/12 grader's phone number?
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Emergency Contact Other Than A Parent:
In the event of illness/emergency we will make every effort to reach parents first. If we cannot reach parents, than we will call this emergency contact.
Name of Emergency Contact (other than parent)(*)
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Relationship to Children(*)
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Emergency Contact Telephone Number(*)
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Physician's Name(*)
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Physician's Phone Number(*)
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On occasion classes may leave the building. If students take a field trip where they leave the immediate area, are transported by bus, or have hours different from the norm, I understand that I will be notified by a separate letter and such trips would require a permission slip.
I give permission for my child(ren) to leave the building for outdoor activities within close walking distance, and I understand that every precaution will be taken with his/her care and transportation. I will assume any liability for any injury incurred.
If I cannot be reached in case of an emergency, I give officials permission to render any emergency care deemed necessary.
Occasionally Am Shalom staff take pictures or make videos of our school programs. We use these to decorate our halls and classrooms, on our Totem display units, on social media, and to publicize school and synagogue programs. Teachers may choose to distribute pictures or videos made of children in their class to the entire class to further enhance their classroom experience. We also stream our sanctuary Shabbat and holiday services in which your child might appear. I grant Am Shalom permission to record and use photographs/videos of my child(ren) in any medium for educational, promotional, or other purposes that support the mission of the congregation.
Filling in your name here constitutes your virtual signature and agreement with the above(*)
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What do you hope your family will gain from religious school at Am Shalom?(*)
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Please check any of the following that you'd like additional information on

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Total Amount Owed for School Payment:
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Amount with credit card fee of 3% if you are paying online:
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