Religious School 2023-2024 Challah Days Registration Form

* Child's First Name:

* Child's Last Name:

Hebrew Name:

* Address:

* City:

* Zip:

* Gender:

* Age:

* Date of Birth:

* 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?

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 that are part of the Callah Days Religious School program.

* Please select one:

Please Select OnePBJC Member Payment ($180)Non-Member Payment ($236)2023-2024 Religious School Challah Days Payment

Thu, September 21 2023
6 Tishrei 5784

Friday Night

Candle Lighting

: 6:37pm

Friday Night Shabbat Services

: 8:00pm

Shabbat Day

Preliminary Prayers

: 9:30am

Shabbat Services

: 9:45am

Junior Congregation Service

: 10:00am

Upcoming Programs & Events

Sep

Junior Congregation Service
Shabbat, Sep 23 10:00am

Sep

No Religious School
Sunday, Sep 24

Sep

Sukkah Set-Up
Sunday, Sep 24 9:00am

Sep

PBJC Office Closed
Monday, Sep 25

Sep

ECC School & Giggle Zone Closed
Monday, Sep 25

This week's Torah portion is Parshat Ha'Azinu

Candle Lighting

Friday, Sep 22, 6:37pm

Shabbat Shuva

Shabbat, Sep 23

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Thu, September 21 2023 6 Tishrei 5784