Registration Form for Passport to Jewish Learning
Thank you very much for enrolling your child(ren) in Rodef Shalom’s innovative, engaging new education program – Passport to Jewish Learning.   If you have questions about tuition and membership, please contact Dawn Spector, Director of Youth Education at 303-399-0035 or dawn.spector@rodef-shalom.org.  
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I would like to enroll my child(ren) listed below for the 2017 - 2018 school year. *
Required
We are: *
Required
Student 1 First Name *
Student 1 Last Name *
Student 1 Date of Birth *
Student 1 Grade *
Student 1 Health and Individual Needs Information - Please check any and all that are important for our staff to know. If there are none, please check none at this time: *
If student doesn't have any allergies, special dietary needs or medications, please check the "None at this time" box
Required
List any Physical Conditions, Specific Learning Needs, Allergies/Special Dietary Needs//Medications for Student 1
Will student 1 participate in the Hebrew Language Program? *
Hebrew Language will be on Wednesdays from 4:30 to 6:00 PM for 2nd – 7th grades and twice a month on Shabbat mornings for K-1st from 10:00 - 11:00 AM. Fees for Hebrew are included in the class fees above.
Required
Do you want to register a 2nd student?
Student 2 First Name
Student 2 Last Name
Student 2 Date of Birth
Student 2 Grade
Student 2 Health and Individual Needs Information - Please check any and all that are important for our staff to know. If there are none, please check none at this time: *
If student doesn't have any allergies, special dietary needs or medications, please check the "None at this time" box
Required
List any Physical Conditions, Specific Learning Needs, Allergies/Special Dietary Needs//Medications for Student 2
Will student 2 participate in the Hebrew Language Program?
Hebrew Language will be on Wednesdays from 4:30 to 6:00 PM for 2nd – 7th grades and twice a month on Shabbat mornings for K-1st from 10:00 - 11:00 AM. Fees for Hebrew are included in the class fees above.
Parent(s) 1 - Name(s) *
Parent(s) 1 - Home Phone Number *
Parent(s) 1 - Cell Phone Number *
Parent(s) 1 - Email Address: *
Parent(s) 1 - Street Address *
Parent(s) 1 - City *
Zip code *
Parent(s) 2 - Name(s)
Parent(s) 2 - Home Phone Number
Parent(s) 2 - Cell Phone Number
Parent(s) 2 - Email Address
Parent(s) 2 - Street Address
Parent(s) 2 - City
Parent(s) 2 - Zip code
Emergency Contact *
Emergency Contact 1 Relationship to Child(ren) *
Emergency Contact 1 Phone Number *
Emergency Contact Name 2 *
Emergency Contact 2 Relationship to Child(ren) *
Emergency Contact 2 Phone *
Physician Name *
Physician Phone Number *
PLEASE NOTE: In addition to completing this form to register your child(ren) for the 2017/2018 school year, we ask that you complete the Tuition Commitment Form, Emergency Contact Form, and Release Form. The Tuition Commitment Form must be received by July 1, 2017 in order to pay the $50 registration fee. After July 1 the registration fee is $100. All other required forms are due by August 1. Again, please give us a call if you have any questions. Contact information is at the top of this form. Thank you so much.
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