2023-2024 School Registration - Form

* Is your family new to our school?

Please Select OneNoYes

Section A: Family Contact Information

* First Name (Primary)

* Last Name (Primary)

* Email (Primary)

* Phone (Primary)

* Relationship to Student(s) (Primary)

* Street Address (Primary)

Street Address Line 2 (Primary)

* City (Primary)

* State (Primary)

* ZIP (Primary)

* Is there a secondary contact?

Please Select OneNoYes, at the same address as the primary contactYes, at a different address than the primary contactIf there is a secondary contact, all emails and mailings will go to both contacts. In case of urgent need, the primary contact will be notified first

* First Name (Secondary)

* Last Name (Secondary)

* Email (Secondary)

* Phone (Secondary)

* Relationship to Student(s) (Secondary)

* Street Address (Secondary)

Street Address Line 2 (Secondary)

* City (Secondary)

* State (Secondary)

* ZIP (Secondary)

* Emergency Contact Name

* Emergency Contact Phone

* Emergency Contact Relationship

* 2nd Emergency Contact Name

* 2nd Emergency Contact Phone

* 2nd Emergency Contact Relationship

Section B: Student Enrollment Information

* Do you require financial aid?

Please Select OneNoYesThere are many impediments to Jewish education but finances should never be one! We ask that every family commits to some financial contribution, however we are happy to discuss financial aid options for any family who needs it. If you select yes, you will discuss your payment ability in a confidential meeting with Rabbi Sherry Grinsteiner.

Student 1 Information

* Student 1 First Name

* Student 1 Last Name

* Student 1 Birthdate

* Student 1 Hebrew Name

Student 1 Nickname (if applicable)

* Student 1 Grade

This is the same as your child's grade in secular school for the 2023/2024 school year, unless other arrangements have been made with the school.

Name of School your child attends

* Student 1 Tuition Rate

Please indicate which class group you are enrolling your child.

* Does your child have any special learning needs the school should know about?

Please Select OneNoYesIf yes, we would love to speak with you before the school year begins so that we are able to discuss the best ways to support your child from the outset. If you are comfortable we invite you to send any documentation ahead of time to relschool@oratid.org

* Are your child's immunizations up to date?

Please Select OneNoYes

* Are there any allergies or medications we need to know about?

Please Select OneNoYes

Student 1 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

Student 2 Information

* Student 2 First Name

* Student 2 Last Name

* Student 2 Birthdate

* Student 2 Hebrew Name

Student 2 Nickname (if applicable)

* Student 2 Grade

This is the same as your child's grade in secular school for the 2023/2024 school year, unless other arrangements have been made with the school.

Name of School your child attends

* Student 2 Tuition Rate

Please indicate which class group you are enrolling your child.

* Does your child have any special learning needs the school should know about?

* Are your child's immunizations up to date?

Please Select OneNoYes

* Are there any allergies or medications we need to know about?

Please Select OneNoYes

Student 2 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

Student 3 Information

* Student 3 First Name

* Student 3 Last Name

* Student 3 Birthdate

* Student 3 Hebrew Name

Student 3 Nickname (if applicable)

* Student 3 Grade

This is the same as your child's grade in secular school for the 2023/2024 school year, unless other arrangements have been made with the school.

Name of School your child attends

* Student 3 Tuition

Please indicate which class group you are enrolling your child.

* Does your child have any special learning needs the school should know about?

* Are your child's immunizations up to date?

Please Select OneNoYes

* Are there any allergies or medications we need to know about?

Please Select OneNoYes

Student 3 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

Student 4 Information

* Student 4 First Name

* Student 4 Last Name

* Student 4 Birthdate

* Student 4 Hebrew Name

Student 4 Nickname (if applicable)

* Student 4 Grade

This is the same as your child's grade in secular school for the 2023/2024 school year, unless other arrangements have been made with the school.

Name of School your child attends

* Student 4 Tuition

Please indicate which class group you are enrolling your child.

* Does your child have any special learning needs the school should know about?

* Are your child's immunizations up to date?

Please Select OneNoYes

* Are there any allergies or medications we need to know about?

Please Select OneNoYes

Student 4 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

Section C: Release Forms

By signing my name below, I give my child(ren) permission to participate in Congregation Or Atid's Helen and Sam Kornblau Religious School. In consideration of my child(ren)'s enrollment as a religious school student, I hereby waive any and all claims against Congregation Or Atid, its agents and its employees that may arise out of any injury, loss or damage suffered by my child(ren) during any religious school activity. I give permission for my contact information to be distributed in a school roster.

* Enter your name below

By typing my name, I confirm I have read, understand and agree to the above.

Medical Release

In case of injury or illness of a child at school, every effort will be made to contact a parent or guardian. The following instructions will remain in force, unless revoked by a parent or guardian.

* If injury or illness is minor, can we give your child first aid?

Please Select OneYesNo

* If injury is serious and parent cannot be contacted, may we contact your child's physician or dentist?

Please Select OneYesNoPlease provide contacts below

* Do we have your permission to call an ambulance?

Please Select OneYesNo

* Do we have your permission to give Tylenol or Motrin?

Please Select OneYesNo

* Physician's Name

* Telephone

* Dentist's Name

* Telephone

At the time of submission, I certify that my child(ren) is(are) in good physical health.

* Medical Release: Enter your name below

By typing my name, I confirm I have read, understand and agree to the above.

Attendance Agreement

We understand that the Helen and Sam Kornblau Religious School meets on Sundays from 9:30 AM - 12:00 PM for Kindergarten - 7th grade students with the optional hour of Hebrew from 12-1:00 PM.(Grades 3-5)
B'nai Mitzvah students will have additional classes with the Rabbi.
Machon schedule is TBD.
If my child is late or needs to be picked up early, I will come into the office to sign my child in or out.

We understand that it is important to attend Shabbat services and will attend as frequently as possible.

* Attendance Agreement: Enter your name below

By typing my name, I confirm I have read, understand and agree to the above.

Field Trip Agreement

I give my child(ren) permission to go on educational field trips sponsored by the Helen and Sam Kornblau Religious School. I understand that they will travel by bus, van, or private car, and will be accompanied by staff and parent chaperones.

Field Trip Agreement: Enter your name below

By typing my name, I confirm I have read, understand and agree to the above.

Media Release

From time to time your child’s photo may be taken in our classrooms or special events. We use these photos in the synagogue newsletter, on our synagogue display boards, the COA website as well as private Facebook groups and other publicity materials.

* I give my permission for my child(ren)'s photo to be used:

Please Select OneOn any materialsOn specific materials with my permissionI do not give my permission for my child’s image to be used

Section D: Congregation Community

You may have noticed that at the top of the form we begin with family information. This is intentional. The work of raising and educating Jewish children cannot be done in the school alone, but is a project of the school, the family and the community. You are not just registering your child(ren) for school today, but in fact your entire family. When you come in the building and spend time learning and volunteering with us, you make a powerful statement to your children that Jewish learning is a lifelong process and that we are all on the same team in creating these experiences for them. Don’t underestimate the subtle power of this statement!

Our Youth Education Committee (YEC) meets every other month to plan and prepare school events. We host Holiday Carnivals, Shabbat programming, Youth Group activities, and Commuity Fundraisers. In addition to the committee itself, we are in need of regular volunteers to properly host each event.

Would you be interested in joining the YEC, or volunteering for school events?

Volunteer Opportunities (check all that apply)

I would like to join the YECI would like to volunteer for some eventsI would like to be a substitute teacherI would like to be a field trip chaperoneI would like to sign up as a room parent

Any other skills or talents you might be willing to share?

Section E: Payment Information

In Jewish tradition, it is the job not only of parents but of the community to provide education for children. The COA community is committed to this obligation. As such, our religious school fee only covers a portion of the cost of our religious school. Fundraising efforts and congregational dues heavily subsidize our children’s education.

Tuition costs include all classroom supplies, study materials, and snacks.

Tuition for Non-members will be billed a $100.00 fee in addition to their Tuition cost and be required to fill out an Honorary Membership Application to meet our insurance requirements.

Tuition may be billed to your account. Payment plans are available. Please arrange this with the office.

Tuition Structure:

Grade	Timing	Cost
Kindergarten - 2nd Grade	Sundays 9:30 AM - 12:00 PM	$560.00
Virtual Hebrew Option for 3rd - 5th Grade (26 sessions)	Weekday TBD Virtual Hebrew classes can be in lieu of or in addition to the in-person Hebrew classes on Sundays Each class will be a private 30 minute session with the Hebrew teacher on weekdays at a time set with the teacher.	$280.00 Tuition for the Virtual Option only
3rd - 7th Grade	Sundays 9:30 AM - 12:00 PM 12:00 - 1:00 PM Extra in-person Hebrew lessons (includes light lunch- Grades 3-5)) B'nai Mitzvah Students will meet with Rabbi Grinsteiner one day during the week	$560.00 $700.00 (includes extra in-person Hebrew lessons - Grades 3-5) $550.00 B'nai Mitzvah fees will be billed in addition to regular Tuition
Machon 8th - 10th Grade	TBD	$150.00

► You have requested financial assistance. Check the box below, then please contact Rabbi Sherry Grinsteiner to further discuss your needs as soon as possible.

Financial Aid Follow-up: I understand and will contact Rabbi Grinsteiner

Total Amount

Tuition amount may be billed. Total payment is due by September 10th, 2023, unless other arrangements have been made with the office (804-740-4747).

I would like to schedule an appointment with Rabbi Grinsteiner to further discuss the information on this form.Please allow 1-2 days for the Rabbi Sherry Grinsteiner to follow-up with you, or email relschool@oratid.org.