Wednesday, March 9, 2011

JACTS Registration Forms

Student Name _______________________________                                                                                    Confidential Registration Page 1 of 3
School Director,
Rabbi Sara Shendelman

Registration 2010-2011

Student Information Please fill out a separate form for each child

Student’s Name _____________________________________________________________________ 
                                  Last                                              First                                  Hebrew?

Age ________ Date of Birth ____/____/____ Grade entering ______ School____________________

Student’s Address _______________________________City__________________ Zip____________

Home Telephone __________________________ Other Telephone __________________________

Child lives with Mother Father Other Please specify:

Parent/Guardian Information Please provide information for each adult child lives with, continue on back if necessary.

Name ______________­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­­_______________                                             Name _______________________________
                Last                     First                      Hebrew                                                                                    Last                  First                               Hebrew

Home address if different from student                                                        Home address if different from student
________________________________                                                    ___________________________________
Home Phone _______________________                                                 Home Phone _______________________
Cell Phone_________________________                                                 Cell Phone____________________________
E-mail____________________________                                                  E-mail_______________________________
School information should be sent to:  Mother  Father  both  Other Guardian

Emergency Information
Please provide the name of a friend or relative who can be reached on Sunday if parent is Not available.
(Please be sure they have consented to act on your behalf)
Name_______________________________ Phone ________________________
Relationship to Child__________________________________________________
Name_______________________________ Phone ________________________
 Relationship to Child__________________________________________________

 Student Name _______________________________                                                                                    Confidential Registration Page 2 of 3
Publicity Release for Minors
We occasionally submit pictures of our activities for publication and/or post them on our website. Please tell us if we have your permission to publish pictures of your child(ren). As a matter of policy we DO NOT identify children by name.
_____ I hereby consent to the publication of photographs, video or quotes by my son/daughter in print or 
on the JACTS website for the school year 2010-2011. 

_____ No, I do not give my permission. 

Parent’s Signature:                                                                   Date 

Field Trip Permission Slip
We occasionally walk away from school grounds to nearby parks, recreation centers, etc. during class as part of the curriculum.
I give permission for my child _______________________ to accompany his/her class on field trips during the school year 2010/2011.

Parent’s Signature:                                                                       Date ____________________________

Additional Information
Does your child have any medical/ condition requiring special care?

If yes, please describe and indicate precautions needed and/or medications taken: _____________________________________

Does your child have any allergies, including FOOD ALLERGIES

If yes, please specify dangerous FOODS and indicate precautions needed:

Are there any learning or behavioral difficulties that we should be aware of? (Confidential) continue on back:
Please specify your goals for your child’s learning and participation at JACTs

Student Name _______________________________                                                                                    Confidential Registration Page 3 of 3

Chochmat HaLev membership?____________ Synagogue/Other Affiliation ________________
Any conversions or adoptions in your family? _________________
Has your child had any previous Jewish education? ____ if yes, indicate name of school and years attended

Enrollment Policy:
    There is a $50 registration fee which can be waived if payment is made all at once.
    Tuition:  Checks should be made payable to JACTS
    Sunday Class Aleph $500
    Sunday Class Bet $750
    B’Nei Mitzvah $1200
    Weekday Aleph/Bet TBD
      If paying full tuition will present a financial hardship, note the adjusted amount your family can pay for tuition. All adjustment requests are subject to both need and availability of funds.

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