SJS Registration 2019-2020 - Form

Student 1 Information

* Full Name

* Birthday

(MM/DD/YYYY)

* Gender

* Street Address

* City, State, Zip

* Grade and School in Fall 2019

* My child is attending:

Nevatim (Learning Experience for ages 0-5)SJS (Kindergarten-7th Grade Sunday Learning Experience)Kadima (5th-7th Grade Bar/Bat Mitzvah Hebrew Program)Kesher/Confirmation (8th-12th Grade Learning Experience)

Medical Information

This information will be kept confidential by the JEC Staff.

* Primary Doctor's Name

* Primary Doctor's Phone

Medications:

Please list any medications your child may be taking.

Please indicate if your child has any of the following:

AsthmaLDADDADHD

* Allergies

Please indicate any allergies your child may have.

* Food Aversions:Are there any foods your child IS NOT allowed to eat? (Please indicate if your child is vegetarian, gluten-free or has any other dietary restrictions)

*SJS will provide snacks on Sundays and Wednesdays.

Temple Emanu-El observes Kosher restrictions on campus which include: no pork, no shellfish and no milk and meat dishes mixed together (example: cheeseburger).

Additional Information

Please share any information that would help us better educate your child.

SJS Medication Policy
Please be aware that the JEC staff is NOT allowed to administer medication to its students. This includes over-the-counter medication (ex. Ibuprofen and Tylenol). If medication is required, please contact admin@shaloha.com.

I understand the JEC medication policy.

Add Student(s):

Student 2 Information

Full Name

Birthday

(MM/DD/YYYY)

Gender

Grade and School in Fall 2019

My child is attending:

Student 2 Medical Information

This information will be kept confidential by the JEC Staff.

Primary Doctor's Name

Primary Doctor's Phone

Medications

Please indicate any and all medications your child is taking.

Please indicate if your child has any of the following:

AsthmaLDADDADHD

Allergies

Please indicate any allergies your child may have.

Food Aversions--Are there any foods your child IS NOT allowed to eat? (Please indicate if your child is vegetarian, gluten-free or has any other dietary restrictions)

*The JEC will provide snacks on Sundays (SJS) and Wednesdays (Kadima).

Temple Emanu-El observes Kosher restrictions on campus which include: no pork, no shellfish and no milk and meat dishes mixed together (example: cheeseburger).

Additional Information

Please share any information that would help us better educate your child.

I understand the JEC medication policy.

Student 3 Information

Full Name

Birthday

(MM/DD/YYYY)

Gender

Grade and School in Fall 2019

My child is attending:

Student 3 Medical Information

This information will be kept confidential by the JEC Staff.

Primary Doctor's Name

Primary Doctor's Phone

Medications

Please indicate any and all medications your child is taking.

Please indicate if your child has any of the following:

AsthmaLDADDADHD

Allergies

Please indicate any allergies your child may have.

Food Aversions--Are there any foods your child IS NOT allowed to eat? (Please indicate if your child is vegetarian, gluten-free or has any other dietary restrictions)

Additional Information

Please share any information that would help us better educate your child.

SJS Medication Policy

Please be aware that the JEC staff is NOT allowed to administer medication to its students. This includes over-the-counter medication (ex. Ibuprofen and Tylenol). If medication is required, please contact admin@shaloha.com.

I understand the JEC medication policy.

Student 4 Information

Full Name

Birthday

(MM/DD/YYYY)

Gender

Grade and School in Fall 2019

My child is attending:

Student 4 Medical Information

Primary Doctor's Name

Primary Doctor's Phone

Medications

Please indicate any and all medications your child is taking.

Please indicate if your child has any of the following:

AsthmaLDADDADHD

Allergies

Please indicate any allergies your child may have.

Food Aversions--Are there any foods your child IS NOT allowed to eat? (Please indicate if your child is vegetarian, gluten-free or has any other dietary restrictions)

Additional Information

Please share any information that would help us better educate your child.

SJS Medication Policy

Please be aware that the JEC staff is NOT allowed to administer medication to its students. This includes over-the-counter medication (ex. Ibuprofen and Tylenol). If medication is required, please contact admin@shaloha.com

I understand the JEC medication policy.

Parent 1--Primary Contact Information

* First Name

* Last Name

* Relationship to child:

Home address (if different from student(s)):

City, State, Zip

* Cell phone:

* Cell Phone Provider*:

*This selection is required.

* Email:

Work phone:

* Best way to get in touch?

Parent 2--Secondary Contact Information

* First Name

* Last Name

* Relationship to child

Home address (if different from student(s))

City, State, Zip

* Cell phone:

* Cell Phone Provider*:

*This selection is required.

* Email:

Work phone:

* Best way to get in touch?

Emergency Contacts-- Other than Primary/Secondary

Emergency Contact 1

* First Name

* Last Name

* Relationship:

* Preferred Contact Number:

* Cell Phone Provider*:

*This selection is required.

* This individual can pick up my child:

YesNo

Emergency Contact 2

* First Name

* Last Name

* Relationship

* Preferred Contact Number:

Cell Phone Provider*:

*This selection is required.

* This individual can pick up my child:

YesNo

Additional individuals to pick up your child:

Full Name

Relationship

Preferred Contact Number:

Full Name

Relationship

Preferred Contact Number:

Photo Consent

* I understand that photographs, images or recordings containing my child’s picture may be used for promotion on the Temple Emanu-El website; social media, including Facebook and Twitter and promotional materials such as brochures by Temple Emanu-El. By checking “Yes” I am granting my permission:

YesNo

Billing

Tuition rates apply to members of Temple Emanu-El, Congregation Sof Ma’Arav, Aloha Jewish Chapel, Oahu Jewish Ohana and Chabad of Hawaii

Please indicate which of the above congregations you are affiliated with:

SJS

1st child: $700
2nd child and more: $650

Kadima

$300 (There is no multiple child discount)
Bar/Bat Mitzvah Training Fee: $500*
- *Fee applicable only to families with children that have scheduled their Bar/Bat Mitzvah this upcoming year (between August 18, 2019-August 18, 2020).

Kesher/Confirmation Tuition:

$100

Nevatim (Sprouts) Program:

Payment Options

I will pay in fullBill me semi-annuallyBill me quarterly

If paying in full: SJS payment due by September 8, Kadima due by October 11

If paying semi annually: first payment, September 8; second payment, January 12

If paying quarterly: first payment September 8; second payment November 10; third payment January 12; fourth payment March 8.

* Select preferred payment method:

Credit Card Payment

A payment link will be available in your confirmation email.