New Student Registration
Oseh Shalom Religious School 2018-2019
Student's Name: *
Your answer
Home Address: *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Hebrew Name *
Your answer
Secular Grade in Fall '18: *
Your answer
Secular School/ County *
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Religious School: (Check All That Apply) *
Required
Parent/Guardian #1 (Name) *
Your answer
Parent/Guardian #1 (Address-- if different from child)
Your answer
Parent/Guardian #1 (Phone Number) *
Your answer
Parent/Guardian #1 (Email) *
Your answer
Parent/Guardian #2 (Name)
Your answer
Parent/Guardian #2 (Address- if different from child)
Your answer
Parent/Guardian #2 (Phone Number)
Your answer
Parent/Guardian #2 (Email)
Your answer
Emergency Contact Information #1: (Name and Phone Number) *
Your answer
Emergency Contact Information #2: (Name and Phone Number) *
Your answer
Pediatrician's Name and Phone Number: *
Your answer
Insurance Company & Policy Number: *
Your answer
Does your Child have allergies or health considerations? *
If yes, please list:
Your answer
Does your Child take medications? *
If yes, please list:
Your answer
Permission for Emergency Medical Treatment: *
Required
Does your child receive services under a 504 plan, an IEP or other formal education plan? *
Tell us about your child's strengths: *
Your answer
What are your expectations for the coming religious school year? *
Your answer
How can we best address your child's needs? *
Your answer
What else would like to share about your child?
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Student Directory/Photo Release:
Registration Deposit: *
Required
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