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2019-2020 Youth Education Registration

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Please complete this form to register your child for Youth Education Programs. Members can save some time by logging in then entering their child's name in the box above the red arrow.

To complete the registration form, you will need: Review our program offerings and fees here

*Please register each child individually on a separate submission.
 

Student Information

Secular School

Information About Your Child

Har HaShem strives to create a safe, welcoming and productive learning environment for every child. Please share information in the following few sections that will help us do this for your child and family.

Learning & Behavioral Differences

Har HaShem aims to include individuals who temporarily or permanently move, hear, see, touch, think, learn, communicate, process stimuli, and/or experience emotions differently. Our youth education programs welcome all children -- whatever their learning style or distinct needs may be -- and we work toward creating meaningful, inclusive learning experiences for all.

We have a learning specialist on staff, Aryn Miller, who works with families to ensure students with different needs are included and helps our educators prepare to accommodate each student's needs.

Please share any information about your child's needs in a learning environment, including but not limited to educational or social concerns, learning differences, behavior, diagnosis or conditions. Any specifics you can share may be helpful to us. Our learning specialist will reach out to you to learn more and discuss possible accommodations.
Please share any information described above to help us help your child.
Please share any information described above to help us help your child.

Diet & Allergy Information

For Youth Education Programming at Har HaShem, all food is kosher style.
(We do not serve pork, or shellfish. We do not mix meat and dairy at a meal.) We are also nut free.


If your child has dietary restrictions, please tell us below.
Please tell us about allergies or other restrictions not listed above.

Medical Information

Please tell us about any medications your child may take during school programs. Har HaShem must know about medications in the building even if your child can take the medication independently.

If we may need to administer medication, please complete the form below, have it signed by your doctor and upload it here or return it to the Har HaShem Lifelong Learning office by August 1.

Staff-Administered Medicine Form

If your child is capable to self-administer medication, please complete the form below, have it signed by your doctor and upload it here or return to the Har HaShem Lifelong Learning office by August 1.

Self-Administered Medicine Form
 

Child Insurance Information

Immunizations

Beginning with the launch of the 2019-2020 academic year, Har HaShem will require proof of immunization or an immunization medical exemption form. for participation in any youth education program or event (school, youth group, camp, etc.). This requirement brings us into alignment with the Youth & Camping Programs of the Reform Movement.

While we are aware parents may choose to defer the vaccination of their children, we believe this is a public health issue, especially in the confined environment of a many of our programs, and discourage deferment for any but medical reasons. Therefore, all students and staff will be required to have age-appropriate vaccines recommended by the Colorado Department of Public Health and EnvironmentAmerican Academy of Pediatrics (AAP), and the Center for Disease Control (CDC).

You will be asked to upload proof of immunization from a doctor or an Immunization Medical Exemption Form as part of the registration process. If your child cannot get vaccines because of medical reasons, you must submit a properly completed and signed official form in that field. This form must be completed and signed by your child’s medical doctor.


Enrollment Information
Please choose grade level and any options specific to your child's grades.

Kitot Kef

Kitot Kef (literally "fun classes") are an opportunity for your child to explore another area of Judaism beyond their grade level curriculum. 

Please select below your child's 1st, 2nd and 3rd choice for Kitot Kef. Your child will have the opportunity to do two of them over the course of the year (approximately six sessions each) and we will do our best to accommodate preferences but cannot guarantee spots.

 


Indivualized Hebrew Program

Hebrew instruction at Har HaShem is individualized. Students work one-on-one with a m'amein (tutor/mentor).

Katherine Schwartz, our Director of Lifelong Learning, meets with all families entering 3rd grade or new to Har HaShem to explain the program and set a course of study. If your child is older than entering 3rd grade and you have not met with Katherine or you want to have a follow up meeting, please schedule an appointment.

Please click here to schedule an appointment with Katherine!

Individualized instruction is required for bar or bat mitzvah.

Mazal Tov! (Congratulations!)

Families will receive a bar or bat mitzvah date and attend the first of several bar mitzvah family programs. (Hebrew tutoring may begin earlier or later than 5th grade based on the individualized plan determined by the family and Katherine.)

Please let us know your plans or interests before we assign a bar or bat mitzvah date.
We'd love to celebrate this milestone with you at Har HaShem as well.
We would welcome the chance to talk with you or hear your thoughts about bar or bat mitzvah.
Eighth Grade Options
Ninth Grade Options

Youth Groups

Har HaShem has three great youth groups!
You will start receiving emails about events for your 3rd to 5th grader (Tzofim), 6th to 8th grader (JYG) and 9th to 12th grader (BTY.) There's no fee to be on the list, but individual programs may have fees to participate.

Student Contact Information

Har HaShem needs this information to communicate with students who may be traveling with us or who are Madrichim in our youth education programs.
When we travel with our high school students, we provide a list of names to the airline, and the name on each ticket must match the name on the passenger's ID.

Adult Information

Tell us about the adults associated with your child.
First Adult
Second Adult
We hope you'll be able to volunteer to provide support for our Youth Programming & Events!
Use the following link to view a short description of each of the Volunteer Opportunities 
We hope you'll be able to volunteer to provide support for our Youth Programming & Events!
Use the following link to view a short description of each of the Volunteer Opportunities 
We rely upon volunteer effort to make our programs run. We welcome your assistance!
We rely upon volunteer effort to make our programs run. We welcome your assistance!

Emergency Contact

If we are unable to reach you or another adult listed above, provide information of other adults we can contact in case of an emergency.

There are three spaces below, please provide information for at least one emergency contact.

Permissions & Releases
Please read the information in the sections below carefully and mark your acceptance as necessary.

Emergency Information / Permission to Seek Treatment

If and when a child requires medical attention, Har HaShem personnel will make every effort to reach a parent or guardian. If we are unable to reach a parent or guardian, the following instruction will remain in force unless revoked by the parent or guardian:

I hereby authorize Congregation Har HaShem or its authorized representative to call my child’s physician (or another physician) for necessary care for my child in case of emergency. I agree to pay all expenses incurred. This authorizations shall remain effective from July 1, 2019 – June 30, 2020.

I further authorize Congregation Har HaShem or its authorized representative to consent to any x-ray examination, anesthetic, medical or surgical diagnoses or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any licensed physician or surgeon, whether at the said physician’s office or licensed hospital. 

I give this authorization in advance of any specific examination, diagnosis, treatment or hospital care being required, and in order to provide authority and power on any and all such examinations, diagnoses, treatments or hospital care which the aforementioned physician in the exercise of his/her best judgment may deem advisable.

Emergency Release / Assumption of Risk

Parents and guardians, jointly and separately, release Congregation Har HaShem, its officers, agents, and employees from all liability for injuries, illness or property damage resulting from my family/child’s participation in Youth Education Programming and all Har HaShem sponsored activities and agree not to make any claim or demand against them for any or all losses or damages to student/family’s person or property. I have completed the above learning and medical information to the best of my knowledge. I have read all of the above and agree to abide by it.

Photography Release

By completing this registration, I hereby give consent for photographs, film, video or sound recordings to be taken of anyone in my family at Congregation Har HaShem or at a Congregation Har HaShem sponsored activity during the 2019-2020 academic year, and I further consent that such photographs/recordings can be used in publications, promotional materials, news releases, film, video, websites or sound productions as directed and approved by Congregation Har HaShem.

If you do not wish for your child's image to be used, please indicate in writing by emailing Derian Le by Monday, September 2, 2019.

Youth Education Policies 

Har HaShem's Youth Education Policies are available online.

Deadlines & Tuition 

Early Registration 
Har HaShem offers a $35 per child discount for children register for full year programs, submit all forms and pay all or at least 25% of tuition and fees by June 14. The discount will be applied to your balance when you submit the registration form and before payment. Please note: if any materials are incomplete or payment is not received, you will not qualify for the discount. 

Late Registration Fee
To assist us in preparing for the coming school year, we ask that you register your child prior to August 1. If you complete registration after August 1, we regret that we will assess a $100 late fee for the family. The easiest way to avoid the late fee is to register now.

Early Withdrawal
The family must notify the school administration in writing of the child’s withdrawal from the program. Tuition will be refunded IN FULL minus a $150.00 processing fee if done prior to the 4th class session, October 20. After the 4th week, there will be no refund.

Thank you for registering early. $35 has been deducted from your tuition. If you would like to waive that discount or make an different contribution to support tuition scholarships, please enter that number here. Your contribution will help Har HaShem welcome all children to our programs.

Membership

Har HaShem membership is required.

Har HaShem operates the Youth Education Programming for the benefit of its members. By submitting this form, you agree that you will join the congregation and fulfill the obligations of membership during the 2019-2020 year, including making a membership contribution (brit tzedakah). Contact Lisa Webber to join Har HaShem.

Whether or not you contact us, we will add your name to the membership roster and add Sustaining Brit Tzedakah ($1,980 a year) to your account. Congregation Har HaShem never denies membership for financial reasons. If you would like to discuss financial alternatives, please contact Alan Halpern.

This is the total of tuition for your children and membership in youth group, if applicable.
Fri, May 24 2019 19 Iyar 5779