(319) 337-3813
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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.
1
Parent information
2
Student Information
3
Emergency Contact
Parent 1
Name
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Email
Phone
Parent 2
Name
First
Last
Address
Street Address
Address Line 2
City
State / Province / Region
ZIP / Postal Code
Email
Phone
Other
Please check all that apply
Discuss learning style or special needs with the Principal
Willing to volunteer for one or two programs a year
Family is a member of Agudas Achim Congregation
Student 1
Name
First
Last
Hebrew Name
Mitzvah Date
Date Format: MM slash DD slash YYYY
Date of Birth
Date Format: MM slash DD slash YYYY
Sex
Male
Female
Grade last Year
Please enter a number from
1
to
6
.
Describe any allergies to food, common substances or medications
Attended Agudas Achim Religious School
Previous Year
Will attend this year
Three year old class
Hebrew School
Sunday School
Student 2
Name
First
Last
Hebrew Name
Mitzvah Date
Date Format: MM slash DD slash YYYY
Date of Birth
Date Format: MM slash DD slash YYYY
Sex
Male
Female
Grade last Year
Please enter a number from
1
to
6
.
Describe any allergies to food, common substances or medications
Attended Agudas Achim Religious School
Previous Year
Will attend this year
Three year old class
Hebrew School
Sunday School
Name
First
Last
Relation to student
Phone
Preferred Hospital
