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2024-25 KI Religious School Registration
Please verify reCaptcha before submitting the form.
*
Confirmation Email Address
*
First Name of Parent or Guardian #1
Last Name of Parent or Guardian #1
Cell
Email
First Name of Parent or Guardian #2
Last Name of Parent or Guardian #2
Cell
Email
Has any of your contact information changed since last year?
Address
Phone Number
Email
First Time Registering
None of the Above
*
Address
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code
*
Home Phone
*
Emergency Contact Name
*
Emergency Contact Relationship
*
Emergency Contact Phone
Family Physician
Family Physician Phone
Insurance Plan Information
Group #/ ID #/ Plan #
Insurance Carrier
*
Permission for Medical Treatment
Yes
No
By checking the "yes" box, I hereby give permission for the synagogue to secure all necessary treatment for the safety and health of my child. I understand that my child will be taken to the nearest hospital or appropriate medical facility as indicated by the emergency. I understand that in case of emergency, every effort will be made to reach me or my designated emergency contact.
How many children will attend religious school?
1
2
3
4
*
Student 1 Name
*
Student 1 Grade
Please Select One
Gan - Kindergarten MEMBER
Gan - Kindergarten NON Member
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Gesher - Member Grades 7 & 8
Confirmation - 9th and 10th Grades
Student 1 Hebrew Name
*
Student 1 Birthdate
*
Student 1 Secular School
Student 1 IEP, 504 Health Plan, Learner Needs
Student 1 IEP
Student 1 504
My child does not have a standing IEP or 504 but I would like to discuss needs my child has as a learner.
N/A
As all students are valued in our learning community, we ask you share with us if your child has an IEP or 504 health plan. Please click the button that pertains to your child and we will be in contact with you. All information shared is confidential.
*
Student 1 - Does your child have any allergies, food allergies or medical concerns?
Please Select One
Yes
No
Student 1 Please describe any medical concerns and list any allergies, food allergies and medication
Student 1 - I give permission for the following medications to be given to my child
Tylenol
Advil
Motrin
None of the Above
*
Student 2 Name
*
Student 2 Grade
Please Select One
Gan - Kindergarten MEMBER
Gan - Kindergarten NON Member
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Gesher - Member Grades 7 & 8
Confirmation - Grades 9 and 10
Student 2 Hebrew Name
Student 2 Birthdate
*
Student 2 Secular School
Student 2 IEP, 504 Health Plan, Learner Needs
Student 2 IEP
Student 2 504
My child does not have a standing IEP or 504 but I would like to discuss needs my child has as a learner.
N/A
As all students are valued in our learning community, we ask you share with us if your child has an IEP or 504 health plan. Please click the button that pertains to your child and we will be in contact with you. All information shared is confidential.
*
Student 2 - Does your child have any allergies, food allergies or medical concerns?
Please Select One
Yes
No
Student 2 Please describe any medical concerns and list any allergies, food allergies and medication
Student 2 - I give permission for the following medications to be given to my child
Tylenol
Advil
Motrin
None of the Above
*
Student 3 Name
*
Student 3 Grade
Please Select One
Gan - Kindergarten MEMBER
Gan - Kindergarten NON Member
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Gesher - Member Grades 7 & 8
Confirmation - 9th and 10th Grades
Student 3 Hebrew Name
Student 3 Birthdate
*
Student 3 Secular School
Student 3 IEP, 504 Health Plan, Learner Needs
Student 3 IEP
Student 3 504
My child does not have a standing IEP or 504 but I would like to discuss needs my child has as a learner.
N/A
As all students are valued in our learning community, we ask you share with us if your child has an IEP or 504 health plan. Please click the button that pertains to your child and we will be in contact with you. All information shared is confidential.
*
Student 3 - Does your child have any allergies, food allergies or medical concerns?
Please Select One
Yes
No
Student 3 Please describe any medical concerns and list any allergies, food allergies and medication
Student 3 - I give permission for the following medications to be given to my child
Tylenol
Advil
Motrin
None of the Above
*
Student 4 Name
*
Student 4 Grade
Please Select One
Gan - Kindergarten MEMBER
Gan - Kindergarten NON Member
Grade 1
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Gesher - Member Grades 7 & 8
Confirmation - 9th and 10th Grades
Student 4 Hebrew Name
Student 4 Birthdate
*
Student 4 Secular School
Student 4 IEP, 504 Health Plan, Learner Needs
Student 4 IEP
Student 4 504
My child does not have a standing IEP or 504 but I would like to discuss needs my child has as a learner.
N/A
As all students are valued in our learning community, we ask you share with us if your child has an IEP or 504 health plan. Please click the button that pertains to your child and we will be in contact with you. All information shared is confidential.
*
Student 4 - Does your child have any allergies, food allergies or medical concerns?
Please Select One
Yes
No
Student 4 Please describe any medical concerns and list any allergies, food allergies and medication
Student 4 - I give permission for the following medications to be given to my child
Tylenol
Advil
Motirin
None of the Above
*
Photography/Video Consent
I give permission for Kesher Israel to use photos/videos of my child
I DO NOT give permission for Kesher Israel to use photos/videos of my child
From time to time, Kesher Israel will publish images or video clips of activities to our KI website, KI Facebook Page, KI ELink, KI Link, and other electronic or printed material that will be accessible to the general public. These activities may be related to Kesher Israel Preschool, the David Ari and Michael Eric Zukin Religious School, Youth Groups. No names will be used in captions. You may choose to grant permission for us to publish photographs or video clips of your child.
David Ari and Michael Eric Zukin Religious School
This permission form is valid from: September 1, 2024 – August 31, 2025.
Sat, November 23 2024
22 Cheshvan 5785
Today's Calendar
Havdalah
: 5:31pm
Friday Night
Candle Lighting
: 4:20pm
Shabbat Day
Havdalah
: 5:28pm
This week's Torah portion is
Parshat Chayei Sara
Shabbat, Nov 23
Candle Lighting
Shabbat, Nov 23, 4:23pm
Havdalah
Motzei Shabbat, Nov 23, 5:31pm
Shabbat Mevarchim
Shabbat, Nov 30
View Calendar
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Sat, November 23 2024 22 Cheshvan 5785
