New to the Jewish Enrichment Center? Enroll Here.

Ready for an extraordinary year at the Jewish Enrichment Center? Please call or write with any questions: 773-234-9403 or jewish.enrichment.center@gmail.com.

Please fill out a separate form for each child. A $50/child deposit is due with this registration form.

If you are human, leave this field blank.

Child's First Name *

Child's Last Name *

Does your child have a Hebrew name? If so, please write it here, or just write "none." *

Who does your child live with? *

Where does your child go to school? *

Grade Level for Fall, 2020 *

Child's Birthdate *

At what time was your child born? (We'll use this information to figure out your child's Hebrew birthday.) *

Names and ages of child's siblings *

Please share the name, address, and email of grandparent(s) and/or special friends who would like to be involved with your child's experiences at the Jewish Enrichment Center. *

Parent/Guardian Information

Parent/Guardian 1 First Name *

Parent/Guardian 1 Last Name *

Parent/Guardian 1 Email *

Parent/Guardian 1 Mobile *

Parent/Guardian 1 Profession *

Parent/Guardian 1 Work Phone *

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Email

Parent/Guardian 2 Mobile Phone

Parent/Guardian 2 Profession

Parent/Guardian 2 Work Phone

Address

Home Address *

Home Address

City

State/Province

Zip/Postal

Home Phone Number

Should mail also be sent to another address (e.g., a second parent)? If so, please note the address below.

City

State/Province

Zip/Postal

Country

Emergency Information

In an emergency, whose phone should we try first? * In an emergency, whose phone should we try first?

Emergency Contact Name (if we cannot reach a parent/guardian) *

Emergency Contact Phone Number(s) *

Is the Emergency Contact authorized to pick up your child? *

Yes

Authorized Person for Pickup *

Some of our families have babysitters, older siblings, or friends who might pick up their child. Please list at least two authorized adults to pick up your child, whether it be routine or in case of an emergency.

Authorized Person for Pickup Phone Number *

Authorized Pickup Person Relationship to Child *

Authorized Person for Pickup 2 *

Authorized Pickup Person 2 Phone Number *

TextAuthorized Pickup Person 2 Relationship to Child *

Health Information

Please list your child’s allergies (animals, food, latex), and their symptoms (breathing problems, runny nose, watery eyes). If applicable, write "none." *

Please list your child’s medications and when they are administered. If applicable, write "none." *

Does your child have an EpiPen? *

Yes

Please note any other health issues. If applicable, write "none." *

Does your child have an Individualized Education Program (IEP) or a behavioral management plan at school? We'd like to understand what helps your child learn. *

Yes

Jewish Community

There are so many ways to be Jewish, and we value all of them. Some of our families have chosen to belong to a synagogue. If synagogue affiliation is part of your family's Jewish life, please indicate which one(s). *

Congregation Rodfei Zedek

KAM Isaiah Israel

Not Affiliated

OtherOther

Does your child or family participate in other Jewish programs? Or would you like to know what's available locally? Please note your participation and/or interests below. (Examples: programs at the JCC, Hebrew play group, Jewish summer camp, etc.) *

New to the Jewish Enrichment Center? Enroll Here.

Parent/Guardian Information

Address

Emergency Information

Health Information

Jewish Community

Registration Information

Donations Welcome!

Register for Summer Camp!

Registration

Calendar

Catch the Latest Blog Posts

Check out our Instagram!

jewishenrichmentcenter

Phone: 773-234-9403

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New to the Jewish Enrichment Center? Enroll Here.

Parent/Guardian Information

Address

Emergency Information

Health Information

Jewish Community

Registration Information

Donations Welcome!

Register for Summer Camp!

Registration

Calendar

Catch the Latest Blog Posts

Check out our Instagram!

jewishenrichmentcenter

Phone: 773-234-9403

Tags

Copyright