Jewish Community Religious School of Central Oregon Registration Form

Parent/Guardian First name

Parent/Guardian Last name

Email

Phone

Address

Address Line 2

City

State

Zip Code

Do you belong to or have you contributed to any of the local congregations? Check all that apply:

Chabad of Central Oregon

Congregation Shalom Bayit

Temple Beth Tikvah

None of the above

Child 1

Child 1 Name

Child 1 grade in September 2024

Child 1 Birthday

Month

Day

Year

Child's Doctor

Doctor's Phone Number

Emergency Contact Name

Emergency Contact Phone

Emergency Contact Relationship

Choose the program(s) you are registering child 1 for:

Sunday School (K-7th, meets twice a month on Sunday mornings)$324

Hebrew School (typically begins in 3rd grade, meets weekly after school)$300

Youth Group (grades 6 and above only)$50

Only if you selected Hebrew School above:

Which year of Hebrew will your child study in 2024-2025?

Students usually enter First Year Hebrew in 3rd grade or at 9-10 years old. Leave blank if you are unsure where to place your child.

Does your child have any allergies, medical issues or food restrictions?

yes

no

If yes, please list below:

Is there anything you want your child's teacher to know about them or their learning style?

yes

no

If yes, please explain below: