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Ramat Shalom Forms 2022-2023
High Holidays Form
Early Childhood Center
Bar/Bat Mitzvah & Hebrew School
What’s Happening
Calendar
Services
Online Prayerbooks
Programs and Education
Youth Group
Life Cycle Events
About Us
Our Story
Meet Our Team
Join Our Community
Payment/Donate
Contact Us
Get In Touch
Ramat Shalom Forms 2022-2023
High Holidays Form
Early Childhood Center
Bar/Bat Mitzvah & Hebrew School
What’s Happening
Calendar
Services
Online Prayerbooks
Programs and Education
Youth Group
Life Cycle Events
About Us
Our Story
Meet Our Team
Join Our Community
Payment/Donate
Contact Us
Get In Touch
Ramat Shalom Forms 2022-2023
High Holidays Form
Early Childhood Center
Bar/Bat Mitzvah & Hebrew School
What’s Happening
Calendar
Services
Online Prayerbooks
Programs and Education
Youth Group
Life Cycle Events
About Us
Our Story
Meet Our Team
Join Our Community
Payment/Donate
Contact Us
Get In Touch
Ramat Shalom Forms 2022-2023
High Holidays Form
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11301 W. Broward Boulevard, Plantation, FL 33325
954-472-3600/ Fax 954-472-3622
ramatshalom@ramatshalom.org
Please indicate which program you are selecting. Please submit one form for each child!
Atid (Kindergarten-2nd Grade)
Machar (3rd Grade-5th Grade)
Child's Name:
*
Hebrew Name:
*
Phone:
*
Email:
*
School:
*
Grade in School 2022-2023:
*
Torah School Grade:
*
Date of Birth:
*
Age on 8/1/22:
*
Identified Gender:
*
Parent 1 Name:
*
Parent 2 Name:
Parent 1 Phone:
*
Parent 2 Phone:
Parent 1 Work Phone:
*
Parent 2 Work Phone:
Parent 1 Email:
*
Parent 2 Email:
Child lives with:
Parent 1
Parent 2
Both
Other
Relationship:
Emergency Information: In case of minor illness or injury of my child at school, I give the school staff permission to give basic first aid to my child. In case of a major injury or illness, I understand that staff will make every effort to contact me. If they are unable to do so, I give permission for my child’s physician and/or an ambulance to be contacted and for a physician to hospitalize and/or secure proper treatment for my child.
In case of an emergency call:
Emergency Contact 1 Name:
*
Emergency Contact 2 Name:
Emergency Contact 1 Phone:
*
Emergency Contact 2 Phone:
Emergency Contact 1 Reltionship:
*
Emergency Contact 2 Reltionship:
My child may be picked up from Torah School by the following people:
Pickup List Name 1:
Pickup List Name 2:
Pickup List Phone 1:
Pickup List Phone 2:
Pickup List Relationship 1:
Pickup List Relationship 2:
List any allergies, medical conditions and/or daily medication: (Please notify the Torah School office of any changes)
Allergies:
Medical Conditions:
Medication:
Please provide any information about your child that may affect the classroom learning:
For example, specific learning issues, special needs, or educational accommodations.
Insurance Company:
Policy Number:
1. Electronic Items: Ramat Shalom is not responsible for any phones or games brought to school. We therefore suggest that you do not bring these items.
2. Publicity Release: I authorize pictures and/or videos of my child to be used for publicity and marketing purposes on the Ramat Shalom website, newspapers, magazines, social media, or marketing materials.
Yes
No
Electronic Signature:
*
Date:
*
Submit
X
X