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Ohav Sholom's After School Hebrew School
Please verify reCaptcha before submitting the form.
Child's information
*
Child's first name
*
Last name
*
Hebrew name
Street address
Street address line 2
City
Zip code
Home phone
Cell phone number
*
Child's birthday
Public School Grade as of 9/22
Name of school
Gan - K
Alef -1
Bet -2
Gimmel - 3
Dalet - 4
Hay - 5
Vav - 6
Zayin - 7
Parent information
Mother's first name
Mother's phone number
Mother's email address
Please choose one:
Born Jewish
Converted
Father's first name
Father's phone number
Father's email address
Please choose one:
Born Jewish
Converted
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
Wed, September 27 2023 12 Tishrei 5784