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PARENT / GUARDIAN # 1

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PARENT  / GUARDIAN  # 2

EMERGENCY CONTACT INFORMATION

MEDICAL INSURANCE COMPANY INFORMATION

Shomrei Torah Media Release Form 

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STUDENT # 1

Child #1 Medical Information

Please check the appropriate statements and provide medical information as appropriate.

Is your child being treated for/have a history of the following:

Please check if your child has had an allergic reaction to any of the following: 

Religious School MEDICATION PROCEDURES:

Please know that there is NO professional medical staff on premises. Please give the Director of Congregational Learning all necessary medications, both over-the-counter and prescription, with the original label, in a clear Ziploc bag and attach your child’s name in LARGE DARK letters, a current photograph of your child, and written permission. All medicines will be kept in an accessible unlocked marked box in the Director of Congregational Learning office. Both the teachers and identified students will know the whereabouts of the box. Please confirm whether or not your child can self-administer medication. Please confirm what specific action(s) should be taken for what symptoms and if the symptoms should be visible or describable.Please describe potential adverse reaction(s) and/or side effects to the medication, and whether or not the child has experienced this before. Guardian/parents are asked to inform Director of Congregational Learning of any change(s) in medication.It is the responsibility of the parent to remove and replace all expired and no longer used medicines, not the Director of Congregational Learning or Religious School. I hereby release and hold harmless Shomrei Torah, its agents, servants, employees and officers from all liability for injuries or other damages which may result to the student from the administration of medication in accordance with the procedures stated herein. TO BE COMPLETED BY PARENT: I give permission for my child to self-administer the medication described above. If the child is unable to self-administer the medication described above and circumstances warrant the administration of the medication, as I have described those circum-stances in writing, below. I give permission of such administration of the medication described above. I will notify the DOCL if this medication is no longer required or self-administration is no longer directed by the physician.

Individual General Learning Profile 

Privacy Notice: This information will be used to enrich your child(ren)’s experience at Shomrei Torah. Confidentiality will be maintained at all times and will only be shared with your child(ren)’s teachers.

Select relevant special learning need(s)

Youth Group Activities

Youth Groups offer informal Jewish educational and fun activities. They meet approximately once a month.

Please confirm whether your child will be a youth group member and select the correct box.

Non member fees will apply when a non member attends an event.

REGISTRATION

Class schedules and costs can be found at the bottom of this form.

Kindly select the class for which you are registering student 2.

END OF STUDENT # 1

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STUDENT # 2

Child #2 Medical Information

Please check the appropriate statements and provide medical information as appropriate.

Is your child being treated for/have a history of the following:

Please check if your child has had an allergic reaction to any of the following: 

Religious School MEDICATION PROCEDURES:

Please know that there is NO professional medical staff on premises. Please give the Director of Congregational Learning all necessary medications, both over-the-counter and prescription, with the original label, in a clear Ziploc bag and attach your child’s name in LARGE DARK letters, a current photograph of your child, and written permission. All medicines will be kept in an accessible unlocked marked box in the Director of Congregational Learning office. Both the teachers and identified students will know the whereabouts of the box. Please confirm whether or not your child can self-administer medication. Please confirm what specific action(s) should be taken for what symptoms and if the symptoms should be visible or describable.Please describe potential adverse reaction(s) and/or side effects to the medication, and whether or not the child has experienced this before. Guardian/parents are asked to inform Director of Congregational Learning of any change(s) in medication.It is the responsibility of the parent to remove and replace all expired and no longer used medicines, not the Director of Congregational Learning or Religious School. I hereby release and hold harmless Shomrei Torah, its agents, servants, employees and officers from all liability for injuries or other damages which may result to the student from the administration of medication in accordance with the procedures stated herein. TO BE COMPLETED BY PARENT: I give permission for my child to self-administer the medication described above. If the child is unable to self-administer the medication described above and circumstances warrant the administration of the medication, as I have described those circum-stances in writing, below. I give permission of such administration of the medication described above. I will notify the DOCL if this medication is no longer required or self-administration is no longer directed by the physician.

**Typing your name below indicates that you affirm the above.

Individual General Learning Profile 

Privacy Notice: This information will be used to enrich your child(ren)’s experience at Shomrei Torah. Confidentiality will be maintained at all times and will only be shared with your child(ren)’s teachers.

Select relevant special learning need(s)

Youth Group Activities

Youth Groups offer informal Jewish educational and fun activities.

They meet approximately once a month.

Please confirm whether your child will be a youth group member and select the correct box.

Non member fees will apply when a non member attends an event.

REGISTRATION

Class schedules and costs can be found at the bottom of this form.

Kindly select the class for which you are registering student 2.

END OF STUDENT #  2

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STUDENT # 3

Child #3 Medical Information

Please check the appropriate statements and provide medical information as appropriate.

Is your child being treated for/have a history of the following:

Please check if your child has had an allergic reaction to any of the following: 

Religious School MEDICATION PROCEDURES:

Please know that there is NO professional medical staff on premises. Please give the Director of Congregational Learning all necessary medications, both over-the-counter and prescription, with the original label, in a clear Ziploc bag and attach your child’s name in LARGE DARK letters, a current photograph of your child, and written permission. All medicines will be kept in an accessible unlocked marked box in the Director of Congregational Learning office. Both the teachers and identified students will know the whereabouts of the box. Please confirm whether or not your child can self-administer medication. Please confirm what specific action(s) should be taken for what symptoms and if the symptoms should be visible or describable.Please describe potential adverse reaction(s) and/or side effects to the medication, and whether or not the child has experienced this before. Guardian/parents are asked to inform Director of Congregational Learning of any change(s) in medication.It is the responsibility of the parent to remove and replace all expired and no longer used medicines, not the Director of Congregational Learning or Religious School. I hereby release and hold harmless Shomrei Torah, its agents, servants, employees and officers from all liability for injuries or other damages which may result to the student from the administration of medication in accordance with the procedures stated herein. TO BE COMPLETED BY PARENT: I give permission for my child to self-administer the medication described above. If the child is unable to self-administer the medication described above and circumstances warrant the administration of the medication, as I have described those circum-stances in writing, below. I give permission of such administration of the medication described above. I will notify the DOCL if this medication is no longer required or self-administration is no longer directed by the physician.

**Typing your name below indicates that you affirm the above.

Individual General Learning Profile 

Privacy Notice: This information will be used to enrich your child(ren)’s experience at Shomrei Torah. Confidentiality will be maintained at all times and will only be shared with your child(ren)’s teachers.

Select relevant special learning need(s)

Youth Group Activities

Youth Groups offer informal Jewish educational and fun activities.

They meet approximately once a month.

Please confirm whether your child will be a youth group member and select the correct box.

Non member fees will apply when a non member attends an event.

REGISTRATION

Class schedules and costs can be found at the bottom of this form.

Kindly select the class for which you are registering student 3.

SCHOOL / YOUTH GROUP SCHEDULE

 and  FEE INFORMATION

SCHOOL

HOORAY FOR HOLIDAYS (PRE-SCHOOL, KINDERGARTEN)

Meets once a month on Sunday mornings 9:30 – 11:00 am - $99 per child

SUNDAY SCHOOL (KINDERGARTEN, 1^ST GRADE, 2^ND GRADE)

Meets once a week on Sunday mornings 9:30 am – 12:30 pm. –   $485  - 1^st child,  $385 per additional child

HEBREW SCHOOL (3^RD GRADE – 7^TH GRADE)

Meets twice a week, Sunday mornings from 9:30 am – 12:30 pm AND Tuesdays, 4:00 – 6:00 pm. -   $840 - 1^st child,  Siblings in 3^rd – 7^th Grade $740 per additional child

Shomrei Torah membership required

YOUTH GROUPS

Youth Groups offer informal Jewish educational and fun activities.

They meet approximately once a month.

CHAVERIM: Kindergarten - Grade 2                                              Meets some Sundays immediately following Religious School.                $50.

PRE KADIMA: Grades 3 - 4                                                             Meets some Sundays immediately following Religious School.                Shomrei Torah Members - $54, non-members - $72.00

KADIMA: Grades 5 - 7                                                                      Meets some Sundays immediately following Religious School.                Shomrei Torah Members - $54, non-members - $72.00

Additional Information to Enrich Your Family's Shomrei Torah Experience 

Your family's expectations from Religious School Education

Please select your family's top 3 -5 priorities from a Shomrei Torah Religious School/Youth Group experience.

You are Important!  This is our religious school and it can only be as strong as the sum of its parts. Throughout the year the Religious School and Youth Programs don’t need much, but we do need some volunteers for various events and activities. We’re not asking you to chair anything but we are requesting that you lend a helping hand. Kindly check what top 3 things you would be willing to do!  Please consider at the very least contributing the same number of hours per year as your child commits per week.