Park Synagogue Education Sunday School Enrollment Data 2024-2025

VIP&Me – 12th Grade
(216) 371-2244, ext. 124 • [email protected]

After you submit your PSWRS Registration Form, the confirmation you receive in your email will contain the link to the tuition payment.

Parent Information

* Parent 1

* Address

Parent 2

Address (if different)

Cell Phone

Student Information

* Student Name

* Birthday

* Grade Sept. 2024

* Secular School

* Student Cell Phone (if applicable)

* Student email (if applicable)

* Hebrew Name

Student Name

Second Student

Birthday

Second Student

Grade Sept. 2024

Second Student

Secular School

Second Student

Student Cell Phone (if applicable)

Second Student

Student email (if applicable)

Second Student

Hebrew Name

Second Student

Student Name

Third Student

Birthday

Third Student

Grade Sept. 2024

Third Student

Secular School

Third Student

Student Cell Phone (if applicable)

Third Student

Student Email (if applicable)

Third Student

Hebrew Name

Third Student

Student Name

Fourth Student

Birthday

Fourth Student

Grade Sept. 2024

Fourth Student

Secular School

Fourth Student

Student Cell Phone (if applicable)

Fourth Student

Student Email (if applicable)

Fourth Student

Hebrew

Fourth Student

For Grades 6-12 The Journey Continues, Bar/Bat Mitzvah & Beyond:

Madrich Program Grades 8 - 12 - Name(s)

Klezmer Band Grades 7 - 12 Name(s)

Palooza & Guardian Games Grades 6 & 7 (Aug. 25) - Name(s)

Charleston Trip Grades 8 - 9 (Sep 20-22) Name(s)

JNF Trip Grades 9-12 (Nov 14-Nov 17) - Name(s)

* Rabbi Skoff's 11th & 12th Grade Class - Name(s)

Attendance

2nd Grade Thursday School

My Child will be attending

3rd-6th Grade Weekday School

Mondays

Thursdays

Will Attend Mondays AND Thursdays

Photo Release

IMPORTANT NOTE: We occasionally submit pictures of our activities for publication and/or post them on our website or Facebook pages. As a matter of policy, we DO NOT identify children by name. If you would like to opt out please check the box below.

Please select if you wish to opt out:

I do not grant permission to the publication of my child on Park Synagogue’s social media accounts (i.e. web & Faceboo

2024-2025 Emergency Medical Authorization

* Family Physician's Name

* Physician's Phone #

* Family Dentist's Name

* Dentist's Phone #

* Emergency Parent Contact Name

* Emergency Parent Contact Phone #

* Emergency Non-Parent Contact Name

* Emergency Non-Parent Contact Relationship

* Emergency Non-Parent Contact Phone #

Please select

I/We grant permission to a hospital and emergency room physician to administer any emergency treatment deemed necessary. This authorization does not cover major surgery unless the medical opinion of two other licensed physicians concurring in the necessity for such surgery are obtained prior to the performance of such surgery.

* Person to Contact if unable to reach parent and has authority to give additional instructions and consent if parent(s) cannot be reached.

Food and other Allergies (if any)

Please give child's name and allergy if filling out for multiple children.

Food sensitivites

Please include child's name and sensitivity if filling out for multiple children.

Medication Being Taken

Please include child's name and medication if filling out for multiple children.

Chronic Illnesses or conditions

Please include child's name and chronic illness or condition if filling out for multiple children.

Learning Challenges

Please include the child's name and learning challenge if filling out for multiple children.

Parent Signature

Tuition

Please submit your form and check your email for the email confirmation. Inside the email confirmation is the link to the tuition form. The tuition form can only be paid after the form has been submitted.

Account Details

E-mail

Enter your name and e-mail address for your confirmation

First Name

Last Name

Payment Information

Account

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

Comments

For added Security please check the box below.

Total:

Park Synagogue Education Sunday School Enrollment Data 2024-2025

Parent Information

Student Information

For Grades 6-12 The Journey Continues, Bar/Bat Mitzvah & Beyond:

Attendance

Photo Release

2024-2025 Emergency Medical Authorization

Tuition

Account Details

Payment Information

Credit Card

Checking Account

For added Security please check the box below.