Religious School Registration 2020-21 You must be a member of Congregation Kol Ami in good standing to enroll your children in Religious School. If there is a financial situation that may require revised payment schedule, please make arrangements with the Congregation Kol Ami Treasurer before the first day of school. Each form will accept up to 5 children. If you need to register more than that, please use an additional form.Please enable JavaScript in your browser to complete this form. - Step 1 of 3Parent's InformationParent Name *FirstLastAddress *Address Line 1Address Line 2CityAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodePrimary Phone *Primary Email *EmailConfirm EmailSecondary PhoneSecondary EmailEmailConfirm EmailCKA has my permission to use photography of my child to be used in promotional materials including but not limited to the CKA website, monthly newsletter, emails, and Facebook page. *YesNoNextEmergency Contact(s)Emergency ContactFirstLastEmergency Contact PhoneSecondary Emergency ContactFirstLastSecondary Emergency Contact PhoneNextChild(ren)'s InformationChild's Name *FirstLastDate of Birth *Hebrew Name (if known)Grade *Pre-K/K1st2nd3rd4th5th6th7th8th9th/High School Year 110th/Hight School Year 211th/High School Year 3Please select the grade this student will be attending in the 2020-21 Religious School year.Medical InformationAllergies (Please List If Any)Medications (Please list if we need be aware.)Emergency Information and Authorization: In case of accident or serious illness, if CKA is unable after reasonable effort to contact me or my emergency contact(s) if listed, I hereby authorize CKA to take my child for medical treatment to the nearest emergency medical facility. I further authorize CKA personnel to apply such first aid as they deem necessary and appropriate. I agree to pay all expenses incurred in the emergency care of my child. By checking the box below, I provide full authorization as indicated above. *I authorize the above.Optional Additional Information about the ChildMy child learns best by:My child follows directions best by:Are there any ways in which we can help your child be more successful in a virtual learning format?What are your goals for your child's formal Jewish learning this year?Any additional comments?Do you have a second child to add?YesNo2nd Child's Name *FirstLast2nd Child's Date of Birth *2nd Child's Hebrew Name (if known)2nd Child's Grade *Pre-K/K1st2nd3rd4th5th6th7th8th9th/High School Year 110th/Hight School Year 211th/High School Year 3Please select the grade this student will be attending in the 2020-21 Religious School year.2nd Child's Medical Information2nd Child's Allergies (Please List If Any)2nd Child's Medications (Please list if we need be aware.)2nd Child's Emergency Information and Authorization: In case of accident or serious illness, if CKA is unable after reasonable effort to contact me or my emergency contact(s) if listed, I hereby authorize CKA to take my child for medical treatment to the nearest emergency medical facility. I further authorize CKA personnel to apply such first aid as they deem necessary and appropriate. I agree to pay all expenses incurred in the emergency care of my child. By checking the box below, I provide full authorization as indicated above. *I authorize the above.2nd Child's Optional Additional Information about the ChildMy 2nd child learns best by:My 2nd child follows directions best by:Are there any ways in which we can help your 2nd child be more successful in a virtual learning format?What are your goals for your 2nd child's formal Jewish learning this year?Any additional comments for your 2nd child?Do you have a third child to add?YesNo3rd Child's Name *FirstLast3rd Child's Date of Birth *3rd Child's Hebrew Name (if known)3rd Child's Grade *Pre-K/K1st2nd3rd4th5th6th7th8th9th/High School Year 110th/Hight School Year 211th/High School Year 3Please select the grade this student will be attending in the 2020-21 Religious School year.3rd Child's Medical Information3rd Child's Allergies (Please List If Any)3rd Child's Medications (Please list if we need be aware.)3rd Child's Emergency Information and Authorization: In case of accident or serious illness, if CKA is unable after reasonable effort to contact me or my emergency contact(s) if listed, I hereby authorize CKA to take my child for medical treatment to the nearest emergency medical facility. I further authorize CKA personnel to apply such first aid as they deem necessary and appropriate. I agree to pay all expenses incurred in the emergency care of my child. By checking the box below, I provide full authorization as indicated above. *I authorize the above.3rd Child's Optional Additional Information about the ChildMy 3rd child learns best by:My 3rd child follows directions best by:Are there any ways in which we can help your 3rd child be more successful in a virtual learning format?What are your goals for your 3rd child's formal Jewish learning this year?Any additional comments for your 3rd child?Do you have a fourth child to add?YesNo4th Child's Name *FirstLast4th Child's Date of Birth *4th Child's Hebrew Name (if known)4th Child's Grade *Pre-K/K1st2nd3rd4th5th6th7th8th9th/High School Year 110th/Hight School Year 211th/High School Year 3Please select the grade this student will be attending in the 2020-21 Religious School year.4th Child's Medical Information4th Child's Allergies (Please List If Any)4th Child's Medications (Please list if we need be aware.)4th Child's Emergency Information and Authorization: In case of accident or serious illness, if CKA is unable after reasonable effort to contact me or my emergency contact(s) if listed, I hereby authorize CKA to take my child for medical treatment to the nearest emergency medical facility. I further authorize CKA personnel to apply such first aid as they deem necessary and appropriate. I agree to pay all expenses incurred in the emergency care of my child. By checking the box below, I provide full authorization as indicated above. *I authorize the above.4th Child's Optional Additional Information about the ChildMy 4th child learns best by:My 4th child follows directions best by:Are there any ways in which we can help your 4th child be more successful in a virtual learning format?What are your goals for your 4th child's formal Jewish learning this year?Any additional comments for your 4th child?Do you have a fifth child to add?YesNo5th Child's Name *FirstLast5th Child's Date of Birth *5th Child's Hebrew Name (if known)5th Child's Grade *Pre-K/K1st2nd3rd4th5th6th7th8th9th/High School Year 110th/Hight School Year 211th/High School Year 3Please select the grade this student will be attending in the 2020-21 Religious School year.5th Child's Medical Information5th Child's Allergies (Please List If Any)5th Child's Medications (Please list if we need be aware.)5th Child's Emergency Information and Authorization: In case of accident or serious illness, if CKA is unable after reasonable effort to contact me or my emergency contact(s) if listed, I hereby authorize CKA to take my child for medical treatment to the nearest emergency medical facility. I further authorize CKA personnel to apply such first aid as they deem necessary and appropriate. I agree to pay all expenses incurred in the emergency care of my child. By checking the box below, I provide full authorization as indicated above. *I authorize the above.5th Child's Optional Additional Information about the ChildMy 5th child learns best by:My 5th child follows directions best by:Are there any ways in which we can help your 5th child be more successful in a virtual learning format?What are your goals for your 5th child's formal Jewish learning this year?Any additional comments for your 5th child?PhoneSubmit my Registration Share this:FacebookTwitterEmailPrintLike this:Like Loading...
