Religious School 2023-2024 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 2023:

* 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):

Please Select OneFull Primary Tuition for PBJC Member ($550)Full Primary Tuition for Non-Member ($650)2023-2024 Primary Tuition Payment

Sat, July 27 2024
21 Tammuz 5784

Today's Calendar

Preliminary Prayers

: 9:30am

Shabbat Services

: 9:45am

Friday Night

Friday Night Family Shabbat Services

: 7:00pm

Candle Lighting

: 7:53pm

Shabbat Day

Preliminary Prayers

: 9:30am

Shabbat Services

: 9:45am

Upcoming Programs & Events

Jul

Executive Committee Meeting
Monday, Jul 29 8:00pm

Aug

Shabbat Dinner Order Pick-Up
Friday, Aug 9 12:00pm

Aug

Shabbat Dinner Order Pick-Up
Friday, Aug 23 12:00pm

Sep

ECC Teacher Professional Development Day
Tuesday, Sep 3

Sep

RS Faculty Meeting & Dinner
Tuesday, Sep 3 4:00pm

This week's Torah portion is Parshat Pinchas

Shabbat, Jul 27

Candle Lighting

Shabbat, Jul 27, 8:00pm

Shabbat Mevarchim

Shabbat, Aug 3

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Sat, July 27 2024 21 Tammuz 5784