Hebrew School Registration

How many children are you registering? *

Tuition is $1785/child. Registration fee of $100/child is due today and will go towards tuition.

Child 1

First Name *

Last Name *

Hebrew Name

Example: David or דוד

Birth Date *

Month

Day

Year

Birth Date Before Sunset *

Adopted? *

Yes

School child is attending in the fall *

Grade child is entering in the fall *

Medical History

List any medications child takes

List any allergies child has to food or medications

Does child need an epi-pen?

any medical, developmental or behavioral issue that we should know about?

Share address of

Registration Fee $

Child 2

First Name *

Last Name *

Hebrew Name

Example: David or דוד

Birth Date *

Month

Day

Year

Birth Date Before Sunset *

Adopted? *

Yes

School child is attending in the fall *

Grade child is entering in the fall *

Medical History

List any medications child takes

List any allergies child has to food or medications

Does child need an epi-pen?

any medical, developmental or behavioral issue that we should know about?

Share address of

Registration Fee $

Child 3

First Name *

Last Name *

Hebrew Name

Example: David or דוד

Birth Date *

Month

Day

Year

Birth Date Before Sunset *

Adopted? *

Yes

School child is attending in the fall *

Grade child is entering in the fall *

Medical History

List any medications child takes

List any allergies child has to food or medications

Does child need an epi-pen?

any medical, developmental or behavioral issue that we should know about?

Share address of

Registration Fee $

Child 4

First Name *

Last Name *

Hebrew Name

Example: David or דוד

Birth Date *

Month

Day

Year

Birth Date Before Sunset *

Adopted? *

Yes

School child is attending in the fall *

Grade child is entering in the fall *

Medical History

List any medications child takes

List any allergies child has to food or medications

Does child need an epi-pen?

any medical, developmental or behavioral issue that we should know about?

Share address of

Registration Fee $

Mother

First Name *

Last Name *

Gender

Street Address *

Street Address Line 2

City *

Postal Code *

State *

Phone Number *

Email *

Is Jewish *

Any conversions in the family? *

Please Explain *

Father

First Name *

Last Name *

Gender

Share address of

Parents are married

Marital Status

Relationship to Father Relationship Type(s)

Street Address

Street Address Line 2

City

Postal Code

State

Kids living with? *

Phone Number *

Email *

Is Jewish *

Pick-up Authorization

List name(s) of those, other than parents, who are authorized to pick up your child(ren) from school:

Enrollment Agreement

To enroll your child(ren) in JEMS Hebrew School all forms must be submitted with the required fees.

Enrollment is considered to be for the entire school year. The school cannot issue refunds or credits for illness, holidays, family vacations, or early withdrawal. In the event that the school is closed due to or resulting from a weather emergency or other unforeseen circumstances, there will be no make-up days, refunds or credits for days that school is not in session.

Parent(s) acknowledge that JEMS Hebrew School serves children who are able to function successfully in a group setting. If, in the judgement of the school's Director, the child is not able to function in a group setting, the parent may be asked to withdraw the child. In the event that the parent is requested to withdraw the child, the Director will work with the parent to identify possible alternative programs suitable for the child.

We give permission for the use of photographs of our child(ren) in print materials, on our website, social media and/or emails. Last names of children are never listed.

We give permission for our name and telephone number(s) to be included in any class list that may be distributed.

Medical Emergencies

I hereby give permission, in the event of an emergency, for the Director, Acting Director, or the Teacher at JEMS Hebrew School to take whatever steps may be necessary for the medical care of my child. I understand that in order for JEMS Hebrew School to assume responsibility for my child, I, or the person(s) whom I have designated to drop off and pick up my child, must sign my child in at the time of arrival and out at the time of departure. I understand that unless there is a need for immediate action, the order of the steps taken will follow, but will not be limited to, the outline below:

1. The parent/guardian will be called. Note: If the parent/guardian is unavailable, the emergency contact person designated by the parent/guardian will be called.

2. If these efforts are unsuccessful the following steps will be taken (order may vary depending on the situation):

a. A physician will be called.

b. The child will be taken to the nearest emergency room accompanied by a staff member.

c. An ambulance will be called to take the child to the nearest emergency room accompanies by a staff member.

In the event of an emergency, if I cannot be reached, I give consent for a Chabad staff member to transport my child to the nearest emergency facility, or to have my child transported by ambulance. I give consent to any emergency facility and physician to administer any necessary medical treatment to my child as the situation may warrant it.

Emergency Contact Name *

Emergency Contact Cell Phone *

If parents cannot be reached and emergency medical advice is needed, permission is given to Chabad Hebrew School staff to phone my child's doctor.

In case of a medical emergency requiring immediate emergency care, I authorize the paramedics to take my child to the nearest hospital, if necessary. It is understood that I will hold Chabad of West Delray and JEMS Hebrew School harmless for the nature and outcome of any emergency medical treatment. It is also understood that I leave the decision of what constitutes an emergency to the sole direction of the staff.

Parent Electronic Signature *

I have provided information, consent, authorization and agreement where indicated, and the information I provided is accurate.

Please send a confirmation email to *

Enrollment Agreement

Medical Emergencies

Delray Jewish Life Center Inc - DBA Chabad of West Delray, Florida