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Congregation Kol Ami Religious School Registration 2022-2023

I am a member of the Synagogue
I am NOT a member, please contact me about Membership

I give my permission to the following persons to pick-up my child/ren from Congregation Kol Ami:

The Following Person/People are NOT authorized to pick up my child/ren:

Yes
No
Yes
No
Yes
No
Yes
No
Yes
No

Please make sure to complete ALL the information requested for each child.

Child #1

He/Him/His
She/Her/Hers
They/Them/Their
Pre K Sunday 9:15-11:15 am (Specific Dates to Follow)
Sunday School 9:15-11:15 am (Grades K-6th)
Tuesday Hebrew School 4:15-6:15 pm (Grades 3rd-6th)
Tuesday Hebrew HIGH School 6:45-8:15 pm (Grades 7th-12th)
Youth Group ($36) Grades K-12th
Madrichim Program ($118) Grades 10th-12th

Confidential Educational Information:

My child has an IEP or 504. I know that I am responsible to provide documentation updated for the 2022-2023 school year before the beginning of school. Students will only receive special services if IEP is current for the upcoming year. Please remember to make an appointment with Adam Roth, Inclusion Coordinator to bring in and discuss before the school year begins.
I give my permission for you to contact the following provider of Special Services if the need arises.
This information may be shared with program coordinator(s) and/or my child's teacher.

Child #2

He/Him/His
She/Her/Hers
They/Them/Their
Pre K Sunday 9:15-11:15 am (Specific Dates to Follow)
Sunday School 9:15-11:15 am (grades K-6th)
Tuesday Hebrew School 4:15-6:15 pm (Grades 3rd-6th)
Tuesday Hebrew HIGH School 6:45-8:15 pm (Grades 7th-12th)
Youth Group ($36) Grades K-12th
Madrichim Program ($118) Grades 10th-12th

Confidential Educational Information:

My child has an IEP or 504. I know that I am responsible to provide documentation updated for the 2022-2023 school year before the beginning of school. Students will only receive special services if IEP is current for the upcoming year. Please remember to make an appointment with Adam Roth, Inclusion Coordinator to bring in and discuss before the school year begins.
I give my permission for you to contact the following provider of Special Services if the need arises.
This information may be shared with program coordinator(s) and/or my child's teacher.

Confidential Medical Information:

Child #3

He/Him/His
She/Her/Hers
They/Them/Their
Pre K Sunday 9:15-11:15 am (Specific Dates to Follow)
Sunday school 9:15-11:15 am (Grades K-6th)
Tuesday Hebrew School 4:15-6:15 pm (Grades 3rd-6th)
Tuesday Hebrew HIGH School 6:45-8:15 pm (Grades 7th-12th)
Youth Group ($36) Grades K-12th
Madrichim Program ($118) Grades 10th-12th

Confidential Educational Information:

My child has an IEP or 504. I know that I am responsible to provide documentation updated for the 2022-2023 school year before the beginning of school. Students will only receive special services if IEP is current for the upcoming year. Please remember to make an appointment with Adam Roth, Inclusion Coordinator to bring in and discuss before the school year begins.
I give my permission for you to contact the following provider of Special Services if the need arises.

Confidential Medical Information:

Parental Agreement and Release

I approve of the above information and registration for my child/ren. I understand that the Director of Congregational Learning or another member of the Temple staff will contact me in case of an emergency. If I am going to be out of town, I will provide information as to how I can be reached in case of an emergency. I hereby grant to the Director to hospitalize, secure proper treatment, order injection, anethsesia or surgery for my child as a result of the foregoing.

Account Details

Enter your name and e-mail address for your confirmation:

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