Moving Traditions: Tzelem

If you see your name at the top right of this window, you are logged in.
If you don't see your name, click login.
Once you've logged in, begin typing and select your name in the box above the red arrow.

The form will pre-fill some information from your account.

Moving Traditions:Tzelem (for 8-9th graders)

We are about to launch Har HaShem's first Tzelem group. Tzelem is group where nonbinary, trans, gender expansive, and LGBTQ+ teens gather monthly with a trained adult mentor. Together in a circle of support, participants experience a brave, sacred space for them to articulate their deepest concerns, consider the impact of gender norms on their daily lives, celebrate and support together through joys and challenges, be their authentic selves with their peers, and explore topics that matter most to them. This class will be held once a month on a Sunday from 4-6. Exact dates TBD.
The cost for Tzelem is $80.

Please contact Karli Atwell at ka@harhashem.org with any questions.

* Parent First Name

* Parent Last Name

* Parent Email

* Student's First Name

* Student's Last Name

Student's email

What pronouns does your student use?

* Is your student currently enrolled in a program at Har HaShem?

The cost for Tzelem is $80 for the 2023-24 school year.

* What grade is your child in?

Immunizations
Har HaShem requires proof of immunization or an immunization medical exemption for participation in any youth education program or event, including youth group and camp. All students and staff are required to have age-appropriate vaccines (including COVID-19) recommended by the Colorado Department of Public Health and Environment, American Academy of Pediatrics (AAP), and the Center for Disease Control (CDC). We believe this is a public health issue, especially now. We allow deferment only for medical reasons.

This requirement aligns with Reform Movement Policy.

If your child is enrolled in a school program at Har HaShem and you have already uploaded their forms you may skip this part.

If you child is not enrolled in a school program at Har HaShem, please upload either proof of immunization or an Immunization Medical Exemption completed and signed by your child's medical doctor.

* Immunization File Upload

Please upload either proof of immunization OR the immunization medical exemption form here. Please note that both of these documents require a signature from your child's doctor.

Student Insurance Information/Physician/Emergency Contact
If your student is enrolled in a school program at Har HaShem you can skip this section - we already have this information on file.

If you student is not enrolled in Har HaShem youth programming - please fill out the sections below.

Medical Insurance Provider

Name of Policy Holder

Plan/Group Number

Policy Number

Student's Physician

Physician's phone number

Emergency contact

Emergency contact phone number

Fri, July 26 2024 20 Tammuz 5784