New Families: Ohav Sholom's Hebrew School

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Child's Information

* Child's first name

* Child's Last name

* Child's Hebrew name

* Street address

* City

* State

* Zip code

Cell phone number

* Child's birthday

* Public School Grade as of 9/24

* Name of school

Gan - KAlef -1Bet -2Gimmel - 3Dalet - 4Hay - 5Vav - 6Zayin - 7

Parent information

* Mother's first name

* Mother's Mobile Number

* Mother's Email address

* Please choose one:

Born JewishConverted

* Father's first name

* Father's Mobile number

* Father's Email address

* Please choose one:

Born JewishConverted

Are there any special learning needs the school should be aware of?

Are there any medical or personal needs the school should be aware of?

Physician's name

Physician's phone number

Emergency information:

Emergency contact #1: Name

Phone number

Relationship

Emergency contact #2: Name

Phone number

Relationship

* In the event of a medical emergency, if I cannot be reached or my emergency contact listed above cannot be reached, Congregation Ohav Sholom has my permission to obtain Medical Treatment for my child by a physician the synagogue has on call. *

I allow Ohav Sholom to use my child(ren)'s photos on social media and/or other promotional materials.

(Inital to allow consent)

Additional Info/Requests/Questions

Sat, July 27 2024 21 Tammuz 5784

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