2023-24 HSRS Student Registration Form - Form

Shalom, Parents!

Welcome to the 2023-24 religious school year for Har Shalom Center for Jewish Living. We look forward to learning with your child(ren). If you have any questions as you fill out the form, please contact Nicki Shamis, Religious School Director, at HSRSDirector@congregationharshalom.org.

Please note: At this time, it is not possible to 'save' your form and return to finish it later. It must be completed in a single session.

* Parent First Name

* Parent Last Name

Parent First Name

Parent Last Name

* Parent Email

Additional Email

* Parent Phone

Additional Phone

* Address

Apartment Number

* City

* State

* Zip

Non-Member Students:
Families with children in grades K through 5 may enroll their children in the Har Shalom Religious School as non-members for a maximum of two years. The additional tuition for non-members is $35/month per child ($315/year, per child)

* Har Shalom Member?

Add your student(s) to the form by clicking on the 'plus' sign below. Click the plus sign again for each additional child. We cannot register your child(ren) without this information!

* Student Name

Student Hebrew Name (if known)

Student Phone

Student Email

* Birthdate

* Grade for 2023/24 school year grade. Preschool, use 'PK'

* Gender

If other, please identify here

Health and Wellness

Please list any known food or environmental allergies, including whether your child requires that an EPI pen be kept onsite. Also, please list any known learning needs we should be aware of (if applicable).

Registration Fee: In order for our teachers to be ready with materials needed on the first day of school, a registration fee for grades K - 7 is due at the time of registration.

Early Bird Registration: May 21 - June 14: $30 per child
Registration starting June 15: $40 per child

Tuition: All pricing shown below is per child per month and includes tuition, security and materials. Please enter the number of children you are registering in each grade.

Har Shalom faces a wonderful challenge this year: Since Fall of 2019, Religious School enrollment has nearly doubled from 63 students to 120+ students. To accommodate our growing student population, larger grades will split into two sections (tentatively grades 1, 2, and 4). Please indicate your family's preference. Understand that we will do our best to meet your request, but cannot guarantee your preferred time as we create balanced classes and keep siblings together.

* Select your family's section preference

Please Select One8:30am - 11:00am10:30am - 1:00pmNo Preference

Beresheet: In the Beginning

Program Fee: $18/month (7 month schedule Oct - May)

Once a month program for Pre-K kids and their adults. *5-year-olds not yet in Kindergarten are welcome to attend.

Number of participating preschoolers in your family

Kindergarten thru 2nd Grade

Program Fee: $85 per month (9 month schedule)
Sunday mornings August 20 to May 19

Please enter the number of students attending in each grade in the fields below.

Kindergarten

1st Grade

2nd Grade

3rd thru 7th Grades

Program Fee: $120 per month (9 month schedule)
Sunday mornings August 20 to May 19
Wednesday evenings August 23 to May 15

Please enter the number of students attending each grade in the fields below.

3rd Grade

4th Grade

5th Grade

6th Grade

7th Grade

Will your child join us for pizza on Wednesday evening?

Yes, 2 slice plan - $10 per child

Yes, 3 slice plan - $15 per child

No, he/she will eat dinner prior to arrival

BBYO Teen Program

This program is open to all teens 8th grade and up!

Program Fee: A separate email regarding registration and cost will be coming from BBYO
Includes: Lifetime BBYO Membership

Number of participating teens in your family

Madrichim Program - Grades 8 - 12

Program fee: Free
Sunday mornings August 20 - May 19.
Teens are not paid, but can accumulate volunteer hours for school. After this registration form is submitted, you will receive a separate email that gives more details about the program, the requirements, and your interests.

Number of students participating in the Madrichim Program

Enter the preferred grade assignment

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.

* Emergency Contact Name

* Contact Phone Number

* Family Physician Name

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, pandemics are unpredictable, and learning looks different than ever before. We 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 staffing, tuition credits are not given for holidays or personal absences.

If you have a unique attendance circumstance, please contact the School Director, Nicki Shamis. If you need to withdraw your child or teen, notify in writing. A written response is proof that the withdrawal request was received. Absence from the program is not confirmation of withdrawal.

* I have read and understand the Withdrawal Policy

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

Releases

* Photo Release

Please Select OneYes, I agree to the Photo ReleaseNo, I do not agree to the Photo ReleaseI give permission to Har Shalom to photograph my child(ren) during Religious School hours. These pictures will be shared in our weekly newsletters and end-of-the-year slideshow, with the possibility of being included on the Har Shalom website and private Har Shalom Religious School Facebook page.

* Medical Release

Please Select OneYes, I agree to the Medical ReleaseNo, I do not agree to the Medical ReleaseIf 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. This release is needed for in-person programming.

* Field Trip & Excursion Release

Please Select OneYesNoI authorize my child(ren) to leave Har Shalom for field trips with adequate supervision and advanced notice during the school year. Transportation to destinations will be through private vehicle of teachers and parent chaperones.

* Sharing of Contact Information

Please Select OneYesNoI give permission for HSRS staff to share my contact information with other HSRS families for events such as, but not limited to, bar/bat mitzvah invitations, birthday parties, grade level gatherings, etc.

Total Due Today