Sign In
Forgot Password
or Sign In With
Powered By
ShulCloud
Login
Donate Now
Home
About Us
Clergy
Staff
Leadership
Candlestick Newsletter
Services
Events
Calendar
Upcoming Events
Past Events
Adult Education With Rabbi Finkel
Cooking With Cantor Toren
ECC
PBJC Preschool
Intro to Preschool
2-Year-Old Program
3-Year-Old Program
4-Year-Old Program (Pre-K)
The Giggle Zone
PBJC Day Camp
Education
Religious School
Challah Days Pre-K
Primary K-2
Aleph-Dalet 3-6
Kitah Hey 7
B'Yachad 8-12
Junior Congregation
Adult Education
Sakolsky-Melzer Scholarship
Get Involved
Clubs and Organizations
Committees
Contact Us
Religious School 2023-2024 Primary Registration Form
Please verify reCaptcha before submitting the form.
*
Child's First Name:
*
Child's Last Name:
Hebrew Name:
*
Address:
*
City:
*
Zip:
*
Gender:
N/A or Unknown
Male
Female
*
Age:
*
Date of Birth:
*
Public/Private School Attending:
*
Grade Entering September 2023:
*
Religious School Grade Enrolling:
Please Select One
Gan (Kindergarten)
Zeraim (1st Grade)
Shorashim (2nd Grade)
*
Parent's Marital Status:
Single
Married
Engaged
Divorced
Widowed
Separated
N/A
Partnered
*
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 Problems
Vision Problems
Asthma
Other
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):
Please Select One
Full Primary Tuition for PBJC Member ($550)
Full Primary Tuition for Non-Member ($650)
2023-2024 Primary Tuition Payment
Fri, March 31 2023
9 Nisan 5783
Today's Calendar
Candle Lighting
: 7:03pm
Friday Night Shabbat Services
: 8:00pm
Friday Night
Candle Lighting
: 7:03pm
Friday Night Shabbat Services
: 8:00pm
Shabbat Day
Preliminary Prayers
: 9:30am
Shabbat Services
: 9:45am
Upcoming Programs & Events
Apr
2
No Religious School - Passover/Spring Break
Sunday, Apr 2
Apr
3
ECC Spring Break - School Closed / Giggle Zone Open
Monday, Apr 3
Apr
4
No Religious School
Tuesday, Apr 4
Apr
4
ECC Spring Break - School Closed / Giggle Zone Open
Tuesday, Apr 4
Apr
5
ECC Spring Break - School Closed / Giggle Zone Open
Wednesday, Apr 5
This week's Torah portion is
Parshat Tzav
Candle Lighting
Friday, Mar 31, 7:03pm
Shabbat HaGadol
Shabbat, Apr 1
View Calendar
Join Our Mailing List
Fri, March 31 2023 9 Nisan 5783
