Hebrew School Registration Form 2024-2025 Student InformationNameDate of Birth MM slash DD slash YYYY Hebrew NamePublic school grade (as of 9/1):Student Information - 2nd ChildNameDate of Birth MM slash DD slash YYYY Hebrew NamePublic school grade (as of 9/1):Student Information - 3rd ChildNameDate of Birth MM slash DD slash YYYY Hebrew NamePublic school grade (as of 9/1):Parent InformationMotherFatherAddressAddress (if different)Home PhoneHome PhoneWork PhoneWork PhoneCell PhoneCell PhoneEmailEmailNames of those authorized to pick up students, other than parents(Come in school to sign child in and out of class and must be able to provide ID)Name & RelationPhoneName & RelationPhoneIn case of emergency, notify:Name & RelationPhoneName & RelationPhoneFamily PhysicianPhoneI hereby grant permission for Congregation Beth David Hebrew School to call our family physician in the event of an emergency if I cannot be reached. If my family physician cannot be contacted, the school may call another physician, or take my child to the South County Hospital Emergency Room.PhotographsI hereby grant permission for my child’s (children’s) photographs to be taken and used in school publicity.About Your ChildThe following information is solely for the purpose of helping us better serve your child and keep your child safe during school. This information will be held in the strictest confidence and is for school use only.Does your child have an IEP (Individualized Educational Plan) and/or IHCP (Individualized Health Care Plan) at his/her public school? IEP only IHCP only Both Special Health Care Needs
