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Religious School Registration

Our congregation includes a variety of family structures, therefore we are asking for information so that we can be more sensitive to the needs of your children. All disclosures will be held in confidence. We welcome comments and will be happy to assist your family in any way that we can. Since it is beneficial to the children when both parents are involved in their religious education, we will send reports to both parents unless otherwise requested.

1Parent information

2Student Information

3Access and Preferences

4

Parent or Guardian 1
Name Parent or Guardian 1*
First Last
Address 1*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email 1*
Mobile Phone 1
Landline 1
Add Another Parent or Guardian
- Parent or Guardian 2
Parent or Guardian 2
Name Parent or Guardian 2
First Last
Address 2
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email 2
Mobile Phone 2
Landline 2

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Student 1
Name Student 1*
First Last
Hebrew Name 1
Date of Birth 1*
MM slash DD slash YYYY
Age Student 1
Please enter a number from 0 to 16.
Student 1 Grade
School Grade Level in current / upcoming schoolyear
- Pre-K
- Kindergarten
- 1st Grade
- 2nd Grade
- 3rd Grade
- 4th Grade
- 5th Grade
- 6th Grade
- 7th Grade
- 8th Grade
Allergies
Describe any allergies to food, common substances, or medications.
Add another student
- Student 2
Student 2
Name Student 2
First Last
Hebrew Name 2
Email used by student 2 to access Zoom
- Use Email 1
- Use Email 2
Email used by student 2 to access Zoom
Date of Birth 2
MM slash DD slash YYYY
Age Student 2
Please enter a number from 0 to 16.
Student 2 Grade
School Grade Level in 2020-2021
- Pre-K
- Kindergarten
- 1st Grade
- 2nd Grade
- 3rd Grade
- 4th Grade
- 5th Grade
- 6th Grade
- 7th Grade
- 8th Grade
Allergies
Describe any allergies to food, common substances, or medications.
Add another student
- Student 3
Student 3
Name Student 3
First Last
Hebrew Name 3
Date of Birth 3
MM slash DD slash YYYY
Age Student 3
Please enter a number from 0 to 16.
Student 3 Grade
School Grade Level in 2020-2021
- Pre-K
- Kindergarten
- 1st Grade
- 2nd Grade
- 3rd Grade
- 4th Grade
- 5th Grade
- 6th Grade
- 7th Grade
- 8th Grade
Allergies
Describe any allergies to food, common substances, or medications.
Add another student
- Student 4
Student 4
Name Student 4
First Last
Hebrew Name 4
Date of Birth 4
MM slash DD slash YYYY
Age Student 4
Please enter a number from 0 to 16.
Student 4 Grade
School Grade Level in 2020-2021
- Pre-K
- Kindergarten
- 1st Grade
- 2nd Grade
- 3rd Grade
- 4th Grade
- 5th Grade
- 6th Grade
- 7th Grade
- 8th Grade
Allergies
Describe any allergies to food, common substances, or medications.

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Other Questions
Emergency contact (other than parents)
Please list their name, phone number, and relation to student.
Preferred Hospital
- UIHC Main Hospital
- UIHC Medical Center Downtown
Discussion of Needs
- I would like to speak with Sonja regarding things such as specific educational or behavioral needs, family concerns, etc.
I hereby grant Agudas Achim permission to use, in perpetuity, the likeness of my minor children in photographic or other form in communications with school families. I hereby release Agudas Achim from any and all liability that may arise out of the use of my likeness.
- Yes
- No
I hereby grant Agudas Achim permission to use, in perpetuity, the likeness of my minor children in photographic or other form in any and all of its publications, and in any and all other media, whether now known or hereafter existing, controlled by Agudas Achim or its licensees. I hereby release Agudas Achim from any and all liability that may arise out of the use of my likeness.
- Yes
- No

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Fees
For synagogue members, tuition costs $450 annually per child. For non, members, it costs $900 annually per child. The pre-K class costs $60 annually for members and $80 for non-members. There is an additional book and material fee of $100 per child for grades 4 and above. Payments may be spaced out, and if this amount is a burden to your family, we can work with you to find a level of tuition that works for you. Any questions or concerns about tuition should be directed to administrator@agudasachimic.org.
CAPTCHA
Phone
This field is for validation purposes and should be left unchanged.

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