Jewish Heritage School Registration

This registration form gives us important information about your child and includes important instructions and authorizations for your child’s care.  We will share this information with our teachers to help enrich your child’s school experience..

Please complete a separate form for each child.

Jewish Heritage School Child Registration

Student Name(Required)
MM slash DD slash YYYY
Hebrew Name
Parent's Hebrew Names
Parent/Guardian 1 Name(Required)
Parent/Guardian 1 Address If Different from student
Parent/Guardian 2 Name
Parent/Guardian 2 Address If Different from student
Health information: Please check any that apply and explain below:
Trip, Medical and Emergency Authorization
If the student becomes injured or ill at school or while participating in a related program, whether at or away from Am Shalom, every reasonable effort will be made to contact you or another specified adult. The following instructions will remain in force unless revoked in writing by you. . 1. I authorize Am Shalom to give my child first aid. . 2. In case of a medical emergency, I authorize Am Shalom to arrange for an ambulance and emergency medical treatment for my child. I understand that I will be contacted as soon as possible. . 3. I give permission for my child to be photographed at school/Am Shalom events, and for the pictures to be used on the synagogue's website and other social media. . 4. If I cannot be reached in case of serious injury or illness, please contact: