HSRS General Release Form - Form - Congregation Har Shalom

Shalom!

This form contains information that applies to every student you register at Har Shalom, including important photo and medical releases.

NOTE: Submit ONE form for your family.

If you have questions or need to submit different information for different children regarding primary address, etc., contact Nicki Shamis at HSRSDirector@congregationharshalom.org or 970-430-6355.

* List all children you are registering (First Name, Last Name)

Family & Emergency Contact Information

* Parent 1 First Name

Parent 1 Last Name

* Parent 1 Email

* Parent 1 Cell Phone

Are Religious School related texts welcome?

YesNo

Are you a current member of Har Shalom

I am interested please contact me.YesNo

Student's Primary Residence

* Street Address

Apt/Unit # (if applicable)

* City

* State

* Zip

* Would you like to add Parent 2 information?

Please Select OneYesNo

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Cell Phone

Religious School related texts welcome?

YesNo

Student's Secondary Residence (if applicable)

Street Address

Address line 2

City

State

Zip

Emergency Contact Information

Please provide the name and number of at least one family member or friend that we may contact if we are unable to reach either parent.

Contact Name

Contact phone number

Contact Name

Contact phone number

Family Physician name

Family Physician phone number

Is there anyone NOT allowed to pick up your child or children? If so, please list that person's full name below.

Withdrawal Policy

We know life happens and have developed a withdrawal policy to keep us all on the same page. Tuition is based on a full school year. In order to maintain our budget and staff contracts, tuition credits are not given for holidays and personal absences. If you have a unique attendance circumstance, please contact the Religious School Director when registering to discuss. If you need to withdraw your child or teen, notify the Religious School Director in writing. A written response is proof that the withdrawal request was received. Absence from the program is not confirmation of withdrawal. Each family must pay full tuition through the end of the month that a withdrawal request is submitted. Withdrawal requests will not be accepted after October 1 of the current school year. If you have a unique attendance or withdrawal circumstance, please contact the Religious School Director to discuss.

* I have read and understand the Withdrawal Policy

Please Select OneYes thank you!I have questions and will contact you. Thanks!

Releases

* Photo Release

Please Select OneI agree to the Photo ReleaseI do not agree to the Photo Release

I give permission to Har Shalom to photograph my child(ren) during Religious School hours and use for publication purposes, whether electronic, print, digital, or electronic publishing via the internet.

* Medical Release

Please Select OneI agree to the Medical ReleaseI do not agree to the Medical Release

If and when the need for medical and/or surgical attention arises during the period of my child(ren)'s official participation in Har Shalom Religious School programs, and listed parents and emergency contacts cannot be contacted, I hereby grant permission for my child(ren) to be treated by qualified authorities at their discretion and that of Har Shalom senior staff.

* Field Trip & Excursion Release

Please Select OneYesNo

I authorize my child(ren) to leave Har Shalom for field trips with adequate supervision and advanced notice during the school year.

Volunteering is Vital (and fun!)

Since Har Shalom relies so heavily upon parental involvement and support, we expect that parents volunteer time each year. We love and appreciate our volunteers, and volunteering is a great way to stay connected to our awesome community of teachers, students, spiritual leaders, and other parents.

Volunteering can take many forms. The most obvious is to sign up with your child’s classroom teacher and just spend a little time in your own child’s class! We also need parents to plan social action projects and events; organize and supervise fundraising; chaperone field trips; serve on the Education Committee; and more!

How will you volunteer this year? We know you want to check them all(!), but be sure to choose at least two.

Serving on the Education Committee (1 meeting per month)Organizing chaperoning or leading social action projects.Chaperoning/driving for Sunday field trips.Substitute teaching.Organizing and/or working at fundraising events.Volunteering in my childs classroom.Helping with Holiday or Shabbat programming.Other. (Contact me about other options.)