Ohavi Zedek Hebrew School Registration Form

5774/2013-2014

Please complete the form below to register your child(ren) for Hebrew School.  A separate form must be completed and submitted for each child you wish to register.
 

Student's Name (Last Name, First Name):  

Student's Full Hebrew Name (Transliterated):  

Male Female

Date of Birth

 [None]   

Is your child born of a Jewish mother or been through a traditional conversion?  Yes  No

Hebrew School Grade Level for 2013-2014
Kitah Gan (K) Kitah Aleph (1) Kitah Bet (2) Kitah Gimel (3) Kitah Dalet (4) Kitah Hey (5) Kitah Vav (6) Kitah Zayin (7)

 

Secular School Attending:
 

Secular School Grade Level for 2013-2014

Please Select One Kindergarten 1st Grade 2nd Grade 3rd Grade 4th Grade 5th Grade 6th Grade 7th Grade Other
 

 Please list the names of family members who can read, write, speak, or understand Hebrew:

For new students, please briefly describe your child's previous formal Jewish educational experience:

Student Lives With

Both Parents Parent 1 Only Parent 2 Only  

Parent/Guardian #1 Contact Info

Name:                  

Address:              

City/State/Zip:     

Phone (work):          

Phone (home):      

Phone (mobile):   

Email Address:   

Parent/Guardian #2 Contact Info

Name:                  

Address:              

City/State/Zip:     

Phone (work):          

Phone (home):      

Phone (mobile):  

Email Address: 
 

Emergency Contact Info

Please list the people we should contact in the event of an emergency in the order they should be contacted.  A parent should be the first contact.  The other two contacts should be people other than parents at different phone numbers.  In the event of an emergency we will attempt to contact the parents first, and then call the other emergency contacts below.

Name 1:  

Phone:   Relationship:  

Name 2:  

Phone:   Relationship:  

Name 3:  

Phone:   Relationship: 
 

Medical Information

Student's Physician's Name and Phone:  

Health Insurance Company:   Policy Number:  

List All Allergies:  

Medical Conditions OZ Should Be Aware Of:  

Medications Child Takes Regularly:
 

If your child has other special needs please describe in the box below.  Please include special services your child may receive in secular school.  If you feel it would be helpful for your child's Hebrew School teacher to contact his/her secular school teacher you may include the contact information below as well.

Parent/Guardian Volunteer Opportunities

Please check if you would like to be a class parent for this child's grade.

Class parents are responsible for assisting the teacher in organizing within the classroom, i.e. – snack schedules, Torah Time schedules, etc. and facilitating their grade's participation in our all OZHS events.

Please check if you would like to join the Hebrew School Committee.

The Hebrew School Committee meets one Sunday morning per month during Hebrew School from September through May.

Please check if you would like to help plan/run the Chanukah Party. 

Please check if you would like to help plan/run the Purim Party. 

Please check if you would like to help plan/run the Educator Appreciation Shabbat.
 

Please check if you would like to help plan/run the Hebrew School Closing Ceremony and Picnic. 

The Ohavi Zedek office is staffed by parent volunteers during Hebrew School hours.  Please indicate below Hebrew School dates that you are available to volunteer in the office:

Please enter dates and times you would like to volunteer.
 

Emergency Medical Care

In case of accident or serious illness, I request the school contact me.  If the school is unable to reach me, I hereby authorize the school and synagogue personnel to seek emergency medial care, including transportation to the emergency room. I hereby authorize the physician in charge to administer whatever treatment necessary at my expense.

(Entering your name below below and making your first Hebrew School tuition payment will serve as an electronic signature.)
 

Parent/Guardian Signature    Date  [None]  
 

Print or Website Publications

I give permission to Ohavi Zedek Synagogue to photograph performances, projects and other special events for publication in our bi-monthly bulletin (The Voice) or in other synagogue publications created for publicity purposes whether in print or on the synagogue website www.ohavizedek.org (No personal information regarding a child's full name, address, phone number or family information will be used.)

(Entering your name below below and making your first Hebrew School tuition payment will serve as an electronic signature.) 

Parent/Guardian Signature   Date  [None]  
 

Tuition

Hebrew School tuition for the 5774/2013-2014 calendar year has not changed and is recorded along with payment information on the 2013-2014 OZ Dues Pledge form you should have received in the mail during the summer of 2013.  It may also be downloaded here. 

Ohavi Zedek never turns away families due to financial circumstances, if you need Hebrew School tuition assistance please contact our Executive Director Peter Pelaia.