Temple Ohev Sholom R.S.Registration Form (2023-2024)
Please complete one form for each student
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Email *
Parent #1 full name  *
Parent 1 email
Parent 1 cell
Parent #2 full name 
Parent #2 email 
Parent 2 cell
Who does child live with? *
Child's Last Name *
Child's First Name *
Is your child new to R.S. or continuing at Temple Ohev Sholom? *
Since what grade has your child attended religious school at Ohev Sholom? *
Does your child have a preferred name or nickname?
Child's Hebrew name if they have one.
Child's Birth Date *
Child's Gender Identity *
Child's complete address
Child's cell if applicable
Who may drive your child home?
Has the child/family experienced any recent events that the school staff/administration should be aware of in order to best support your child.
 *
What grade is you child enrolled in at school? *
Are there any other important things for us to know about your child? If your child has learning differences please let us know how best to meet their needs. *
Does your child have any allergies that we should be aware of? *
Emergency Contact
Full Name & number *
Relationship to child *
What is your child's primary care doctor name (or office)? *
Primary care phone # *
PARENT/GUARDIAN (BOTH, IF APPLICABLE) MUST READ AND SIGN THE FOLLOWING
I/We certify that the student for whom this application is made is in good health and up to date on all vaccinations. I/We give consent to Temple Ohev Sholom and its Religious School Director, Rabbi, teacher, and/or other officers, designees, agents, or representatives of same, to make available to the student professional medical care as needed in an emergency. It is understood that a conscientious effort will be made to contact at least one of the parents/guardians and/or the student’s physician before such action is taken. However, in the event that such contacts are unsuccessful or not possible, I/we give permission for the student to receive proper medical care by any doctor, nurse, paramedic, or member of a medical staff of a hospital licensed by the Commonwealth of Pennsylvania.

I/We give the student for whom this application is made permission to participate in all activities, including field trips, which are part of Temple Ohev Sholom’s Religious School program. I/we understand that transportation for these field trips will be provided by carpools driven by other school parents/guardians, the Religious School Director, Rabbi, or teachers. I/we further understand that photographs may be taken at such activities and used in temple or community publications and/or websites and that I/we must separately notify the Religious School Director in writing before the first day of school in order to exclude the student from such photographs.

I/we waive any and all liability by, and hold harmless, Temple Ohev Sholom and its Religious School Director, Rabbi, teacher, and/or other officers, designees, agents, or representatives of same for any actions taken based on the foregoing.

Our family and student(s) will comply with the temple's COVID-19 health and safety protocols.  We voluntarily assume all risks and consequences of participating in Religious School and waive all claims and release and hold harmless Temple Ohev Sholom and its Religious School Director, Rabbi, teacher, and/or other officers, designees, agents, or representatives relating to exposure to or infection by COVID-19.


PRINTING YOUR NAME(S) BELOW WILL SERVE AS YOUR ELECTRONIC SIGNATURE AND AGREEMENT TO THE FOREGOING
Parent 1 Name Signature
 *
Parent 2 Name Signature
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