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18-19 Youth Education Registration

Please complete this form to register your child(ren) for religious school. Members can save some time by logging in. The form will prefill some information. To complete the registration form, you will need:
  • your medical insurance information 
  • If your child will or may take medications while at Har HaShem programs and events,
    you will need to complete and submit the downloadable medical release form. Note that this form requires a physician's signature.
  • If your child receives specialized services, supports, accommodations or interventions at secular school, we'll ask you to upload any documents for our reference.
Review our program offerings and fees here.

Members who are logged in to our website will see a partially completed version of this form. To log in, click the link at the top right of this window and enter your ID and password.
If you have more than three children to register, complete this form for the first three children and reopen the form for the additional children. If you are logged in, family information will be saved and re-entered into the form automatically. 
Names
Birthdays and Pronouns
Secular School

Har HaShem aims to create a safe, welcoming and productive learning environment for every child. Please share information that will help us do this for your child and family.


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 who helps our educators prepare to accommodate each student's needs.

If you have any information about your child's needs in a learning environment, including diagnosis, condition, educational or social concern, learning difference, challenge with behavior, or any other distinctions of which we should be aware, please indicate below. We will reach out to you for more information.
 About My Child's Learning
Please share any information described above to help us help your child.
Please share any information described above to help us help your child.
Please share any information described above to help us help your child.
Please share any information described above to help us help your child.
Please share any information described above to help us help your child.
Please share any information described above to help us help your child.

Please tell us about any medications your children will take during youth sessions (including youth group events and retreats if applicable). Even if he/she/they can take the medication independently, Har HaShem needs to know. 

If we may need to administer medication, please download this medical authorization form. Complete the form, have it signed by your doctor and upload it here or return it to the Har HaShem office by August 1, 2018. You may upload it here, if you have already completed it.
 

At Har HaShem, all food is kosher style and nut free (for youth education programming). We do not serve pork, shellfish or nuts. We do not mix meat and dairy at a meal. 

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

Please choose grade level and any options specific to your children's grades.

Hebrew instruction at Har HaShem is individualized. Students work one-on-one with a m'amein (tutor/mentor). Katherine Schwartz, our Director of Lifelong, meets with all families entering 3rd grade or new to Har HaShem to explain program and set a course of study.

Individualized instruction is required for bar or bat mitzvah.
Mazal Tov! (Congratulations!)
Fifth grade is when Har HaShem begins preparing families to celebrate bar or bat mitzvah. Some children begin earlier and some children start later (and celebrate later).

Please let us know your plans or interests.
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.
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.
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

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

BTY membership, for 9th to 12th graders, includes dues to NFTY (National Federation of Temple Youth). Individual programs may have fees to participate.

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.
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.
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(ren).
First Adult
Second Adult

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.

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


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, 2018 – June 30, 2019.

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.

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 Religious School 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.

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 2018-2019 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 Lynn Maldonado by Monday, September 17, 2018.
Har HaShem's Youth Education Policies are available online.

Early Registration 
Har HaShem offers a $70 per family discount for families who submit all registration materials and pay all or at least 25% of tuition and fees by June 15. Please note: if any materials are incomplete or payment is not received, you will not qualify for the discount. And the discount is not applicable to BTY membership.

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 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 14, 2018. After the 4th week, there will be no refund.

New Members, please note:
New members joining the congregation prior to the beginning of the school year and registering children for religious school will receive a $70 per family discount on tuition regardless of date, until the beginning of religious school classes. New members are not subject to the late registration fee, which will be credited in the office, once registration is submitted.

Har HaShem membership is required.
Har HaShem operates the religious school 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 2018-19 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.
Wed, April 24 2024 16 Nisan 5784