Religious School 2022-2023 Primary Registration Form

* Child's First Name:

* Child's Last Name:

Hebrew Name:

* Address:

* City:

* Zip:

* Gender:

* Age:

* Date of Birth:

* Public/Private School Attending:

* Grade Entering September 2022:

* Religious School Grade Enrolling:

* Parent's Marital Status:

* Primary email used for communication:

Secondary email (optional):

* Parent/Guardian 1 First Name:

* Parent/Guardian 1 Last Name:

Parent/Guardian 1 Hebrew Name:

Parent/Guardian 1 Home Phone Number:

Parent/Guardian 1 Work Phone Number:

* Parent/Guardian 1 Mobile Phone Number:

Parent/Guardian 2 First Name:

Parent/Guardian 2 Last Name:

Parent/Guardian 2 Hebrew Name:

Parent/Guardian 2 Home Phone Number:

Parent/Guardian 2 Work Phone Number:

Parent/Guardian 2 Mobile Phone Number:

Sibling Name (not yet enrolled in Religious School):

Sibling Birth Date:

Sibling Name (not yet enrolled in Religious School):

Sibling Birth Date:

Are there any custody arrangements that we need to be aware of?

Please list and describe any allergies your child has (food, medications, insect bites, etc.).

Does your child have any of the following (check all that apply):

Hearing ProblemsVision ProblemsAsthmaOther

If yes, or other, please provide additional information.

Does your child take any medications? If yes, please list them here.

Has your child been evaluated and classified as ADD, ADHD, NI or any other special learning situation?

What are the learning accommodations your child has in school? (Mainstream, self-contained, tutorial, learning center environment)

Is there an educator or learning specialist from secular school that you would like us to be in contact with to assist us in planning for your child? If so, please provide their name and contact information here. Please also feel free to separately share with us any educational reports or the education section of your child's Individual Education Plan or 504 Plan that would enable us to help your child succeed.

Name two emergency contacts who will assume temporary care of your child in an emergency or lockdown situation, only if you cannot be reached.

* Emergency Contact 1 Name:

Emergency Contact 1 Home Phone Number:

Emergency Contact 1 Mobile Phone Number:

* Emergency Contact 2 Name:

Emergency Contact 2 Home Phone Number:

Emergency Contact 2 Mobile Phone Number:

* Name of Child's Physician:

* Physician's Phone Number:

* Virtual Signature. By writing my name below, I hereby give my consent to the Religious School Director/Administrator, or person designated as such, to make available to my child professional emergency medical care if such care is indicated. It is understood that a conscientious effort will be made to notify my spouse or me before such action is taken. It is further understood that every effort will be made to contact my child's physician prior to any treatment. However, in the event that this is not possible, I give my permission for my child to receive proper medical care by any doctor, nurse, ambulance personnel, paramedic or member of the medical staff of a hospital licensed by the Sate of New Jersey. This is also to certify that my child is in good physical health. He/she has my permission to participate in all activities (including field trips) that are part of the Religious School program.

* Payment Amount ($550 full payment for PBJC Members, $650 full payment for Non-Members):

2022-2023 Primary Tuition Payment

Mon, November 17 2025
26 Cheshvan 5786

Friday Night

Candle Lighting

: 4:17pm

Friday Night Shabbat Services

: 8:00pm

Shabbat Day

Preliminary Prayers

: 9:30am

Shabbat Services

: 9:45am

Upcoming Programs & Events

Nov

Religious School
Tuesday, Nov 18 4:00pm

Nov

RS PBJC Teens
Thursday, Nov 20 6:00pm

Nov

Sisterhood Paid Up Event - Flavian Mind Reading Game Show
Thursday, Nov 20 7:00pm

Nov

Deadline to Donate to the Shoe and Sneaker Drive
Sunday, Nov 23

Nov

Religious School
Sunday, Nov 23 9:00am

This week's Torah portion is Parshat Toldot

Shabbat, Nov 22

Candle Lighting

Friday, Nov 21, 4:17pm

Rosh Chodesh Kislev

Friday, Nov 21

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Mon, November 17 2025 26 Cheshvan 5786