Registration: Chai 5 at TOS (including TELEM and The Tent: A Jewish Learning Community for Greater Boston Teens)
Temple Ohabei Shalom is thrilled to be launching Chai 5, our new innovative program for teens.

Please use this form to sign up for Chai 5 for the year!

You can also specify if you will be doing TELEM, our once-a-week volunteering program at the Boys & Girls Club on Wednesday nights, as well as our new partnership with The Tent at Temple Israel.

We are excited to collaborate with The Tent this year, an evening program that connects teens with a diversity of voices to strengthen them as learners, as thinkers, and as young American Jews. Our program is open to all interested teens, grades 8 through 12.

The Tent is hosted at Temple Israel on Monday evenings, with 5:45pm dinner followed by two class options (6:40-7:30 and 7:40-8:30). The teens will choose their classes from a diverse array. Classes run from September to May.

The cost for Chai 5 for the year is $360. If you will also attend The Tent, there is an additional tuition cost of $360 for the year (it is heavily subsidized by TOS, as we want to encourage all teens to be a part of this). Payment can be made to the TOS office via check, or as a part of your dues.

Required fields are marked with a red asterisk [*]. Please note, the entire form must be completed in order for your responses to be submitted and saved.

Questions? Reach out to ars@ohabei.org

What's Your Focus?
You can choose your focus below. Will you sign up for only Chai 5? Will you sign up for Chai 5 and The Tent at Temple Israel? Will you sign up for Chai 5 and TELEM? Or will you sign up for all three?
I am registering my teen for... *
Teen's Name *
Your answer
Teen's Preferred Name
Your answer
Teen Hebrew Name *
Your answer
Teen Gender Identity *
Required
Teen Date of Birth *
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DD
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What public/private school is your teen currently attending? *
Your answer
Teen Email *
Your answer
Teen Grade for the 2017-2018 school year *
Teen Phone Number *
Your answer
Teen Address *
Your answer
Parent Information
Parent 1 Name *
Your answer
Parent 1 Email *
Your answer
Parent 1 Phone *
Your answer
Parent 1 Address *
Your answer
Parent 2 Name
Your answer
Parent 2 Email
Your answer
Parent 2 Phone
Your answer
Parent 2 Address
Your answer
Emergency Contact
Emergency Contact *
Please list the name(s) and phone number(s) of who should be called in an emergency.
Your answer
Carpool
Are you interested in carpooling to the Tent on Monday nights? *
If so, we will share your contact information with other interested families.
Information about Teen
Does your teen have a IEP or 504 Accomodation Plan? If yes, please indicate which one, and please bring an up to date copy to the office. *
What is your teen's learning style? Do you have any advice for your teen's teacher on how to be most successful in educating them?
Your answer
Has your teen been to Israel? *
What is your teen doing this summer? In particular, if your teen is involved with a summer camp, please tell us which camp, and if your teen traveled to Israel, please share a little about that trip. *
Your answer
Is there anything else you feel your teen’s teachers should know about her/him? (e.g. nickname, hobbies, interests etc.) *
Your answer
Please inform us of any unusual events that have occurred recently which may affect your teen’s experience at Chai 5, The Tent, or TELEM.
Your answer
Does your teen have any reading or language challenges? Does he/ she receive support services in regular school?
Your answer
Medical Information
If you do not want to fill out the medical information section, please email your child's doctor's health form from his/her most recent physical exam to ars@ohabei.org
In order for your son/daughter to receive the best care during events, please describe any physical or emotional conditions of which staff should be aware:
Your answer
List any medications your teen takes:
Your answer
Please describe any treatment and/or restrictions on activity:
Your answer
Allergies to food, drugs and/or special diet: *
Your answer
Hospital/Clinic Preference *
Your answer
Insurance Carrier & Policy #: *
Your answer
Physician's Name and Phone Number: *
Your answer
This health history is correct as far as I know. The teen or teens herein described has my permission to engage in all prescribed activities except as noted above. * I release the Tent, Temple Ohabei Shalom, and the staff from all responsibilities other than program, included meals, and supervised and scheduled activities. In the event I cannot be reached in an emergency, I hereby authorize the physician selected by Temple Israel staff or Temple Ohabei Shalom staff to hospitalize, secure proper treatment for, and order injections, anesthesia, or surgery for my teen named above. By entering my name on this line/in this box I declare that the information submitted online is accurate to the best of my knowledge. *
Please enter your name.
Your answer
Temple Ohabei Shalom and The Tent will not, under any circumstances, provide over-the-counter medications (i.e. pain relievers, decongestants, etc.) to your teen without your consent. If you would like to provide blanket consent for the entire school year for Temple Ohabei Shalom staff or Temple Israel staff to dispense over-the-counter medications to your teen, at your teen’s request, please specify below. *
Emergency Contacts
Emergency Contact 1: Please list the name, phone number, email, street address, and relationship to your teen. *
Your answer
Emergency Contact 2: Please list the name, phone number, email, street address, and relationship to your teen. *
Your answer
Permissions
For The Tent Only: Activities in the The Tent Education Program sometimes occur outside the building. These include outings, class field trips and Youth Group events either walking, in a car, on the MBTA, or in a bus. Parents always are notified in advance of any trip that requires a bus or car. I/we understand that the school will do all that it can to ensure the safety of our child. This Acceptance Agreement releases The Tent and all its personnel, employees, and representatives from liability in case of accident or injury resulting from all causes in connection with outings, field trips, or other activities which necessitate travel away from the Tent, which I/we may authorize from time to time, except for those involving gross negligence or intentional misconduct on the part of such personnel, employees, and representatives. I/we empower the Tent staff to act for me/us in accordance with their best judgment in case of an emergency, after unsuccessful attempts to reach the parent(s) or guardian. In the event of an emergency, the Tent will always attempt to reach the parent(s) or guardian first. I/we hereby authorize Temple Israel staff to transport my/our child by ambulance (or police) to the nearest hospital in order to obtain necessary medical treatment if the Tent cannot reach a parent. *
Please enter your name below to indicate acceptance of this.
Your answer
I grant permission to use any and all written comments, pictures, video, and/or movies in which my teen may appear for ongoing professional development for teachers of the Tent. *
I grant permission to use any and all written comments, pictures, video, and/or movies in which my teen may appear for publicity, promotion, and advertising on behalf of Temple Ohabei Shalom or The Tent and its programs. This includes, but is not limited to: email blasts, website photo galleries, etc. *
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