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Sign Up for a Youth Pass 2021-22

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Once you've logged in, begin typing and select your child's name in the box above the red arrow.

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

Carve Your Own Path!

We are excited to offer different passes that give you the choice of what to learn, when to learn it, and how deeply to engage with others on your journey. 

Learn about the Journey, ICAN, and EPIC Passes


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Please complete this form for each child.

Members: start by typing your child's name in the box above the red arrow.

To complete the registration form, you will need:

  • Medical & Insurance Information, Proof of Immunization (or Immunization Medical Exemption Form)

  • If your child may need to take medication while attending programs, you will need one of the following documents:  Staff Administered Medicine Form OR Student-Administered Medicine Form. Both of these documents require 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.


Program offerings by age
Pre-K - 2 Programs
Grades 3 - 5 Programs
Grades 6 - 8 Programs
Grades 9 - 12 Programs


Student Information

Secular School


Choose a Pass

Our programs provide you with the choice of what to learn, when to learn it, and how deeply to engage with others on your journey. Learn more about the Journey, ICAN, and EPIC Passes. Choose a pass now. As the year unfolds, you let us know which specific programs and activities you will attend. Your pass gives you access to an array of options you can choose to meet your needs.

Please note that if you are choosing the EPIC Pass because of your child's b'nai mitzvah, you should choose it for the year you do Masa, our b'nai mitzvah preparation program, which happens in the year PRIOR to b'nai mitzvah (usually 6th grade).

Which of these ongoing programs which begin in the fall will your child or family attend? Please note that sign-ups for kehilah gatherings, youth group events and intensives will be available several weeks before the start of the program and will be announced in our weekly Thursday email and therefore are not listed below.


Individualized 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 entering 3rd grade or older and you have not yet met with Katherine or you want to have a follow up meeting, click here to schedule an appointment.

Individualized instruction is required for b'nai mitzvah.


Mazal Tov! (Congratulations!)

We assign b'nai mitzvah dates in the child's 5th grade year.  Please let us know your plans.

(Hebrew tutoring may begin earlier or later than 5th grade based on the individualized plan determined by the family and Katherine.)

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.

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 Youth Education 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 Chris Specht via email by September 1, 2021.

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 Chris Specht via email by September 1, 2021.

Self-Administered Medicine Form


Child Insurance Information


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 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.

Please upload either proof of immunization or an Immunization Medical Exemption completed and signed by your child's medical doctor. 

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.

Adult Information

Tell us about the adults associated with your child.

First Adult

Second Adult


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.


Student Contact Information

Har HaShem needs this information to communicate with our middle and high school students.

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.

Assumption of Risk

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.

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.

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 authorization shall remain effective from July 1, 2021 – June 30, 2022.

I further authorize Congregation Har HaShem or its authorized representative to consent to any x-ray examination, anesthetic, medical or surgical diagnosis 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 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, diagnosis, treatment or hospital care which the aforementioned physician in the exercise of his/her best judgment may deem advisable.

Acknowledgement of Risk: Covid-19 and Other

I understand that by attending or participating in this program, I may be exposed to viruses, bacteria, chemicals or other substances that may cause me to get sick, sustain bodily injury, and potentially die. These viruses include, but are not limited to, influenza and COVID-19.

I acknowledge that such precautions as may have been taken by Congregation Har HaShem (Boulder Jewish Fellowship) and their Officers, Trustees, Board Members, Staff, Employees, their agents, do not eliminate all risk, including risk of transmission of COVID-19.

I agree to follow and abide by the Behavioral Agreement and acknowledge that following that agreement does not eliminate all risk, including risk of transmission of COVID-19 and other viruses or bacteria.


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 between now and June 30, 2022, 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 Chris Specht at cs@harhashem.org by Monday, September 13, 2021.


Membership

We offer the Journey or ICAN Pass to members (at a discount) and non-members. Families selecting the EPIC Pass must maintain a congregational membership during the program year.

All of Har HaShem's members support our educational and social programs for children
.


Contact Lisa Webber to join Har HaShem.

If you choose the EPIC Pass,whether or not you contact us, we will add your name to the membership roster and add Sustaining Brit Tzedakah ($2,100 a year) to your account. Congregation Har HaShem never denies membership for financial reasons. If you would like to discuss financial alternatives, please schedule an appointment with Alan Halpern.

Sun, September 26 2021 20 Tishrei 5782