Religious School Enrollment 2022-2023 - Form

Parent / Guardian Information

* Number of Adults

Parent / Guardian 1 Information

* First Name

* Last Name

* Preferred Pronouns

* Street Address

* City

* State

* ZIP

* Cell Phone

Home Phone

* Email

Preferred Method of Communication

Parent / Guardian 2 Information

* First Name

* Last Name

* Preferred Pronouns

* Cell Phone

* Email

Emergency Contact
This must be someone different than the parent(s) or guardian(s) listed above.

Name

Relationship

Phone

Student Information

Number of Students You're Enrolling

* First Name

* Last Name

Hebrew Name with Parents

If you need assistance with your Hebrew name, please contact the Rabbi at rabbi@conkolami.org and he will happily assist you.

* Preferred Pronouns

* Date of Birth

* Grade Level for 2022-2023

* Secular School District

* Secular School Name

Are there any academic, behavioral, emotional needs that may impact student’s experience at Religious School?

NoYesThe RSRS Director will contact your for more information.

Does the student have any allergies? If yes, please list them.

Do you want to OPT OUT of KAJY (3rd – 8th grades)?

Upload Proof of COVID Vaccination

We are currently requiring proof of vaccination, including a booster for those eligible (ages 12+)

Already submitted proof of COVID vaccinationChild under the age of 5

* First Name

* Last Name

Hebrew Name with Parents

If you need assistance with your Hebrew name, please contact the Rabbi at rabbi@conkolami.org and he will happily assist you.

* Preferred Pronouns

* Date of Birth

* Grade Level for 2022-2023

* Secular School District

* Secular School Name

Are there any academic, behavioral, emotional needs that may impact student’s experience at Religious School?

NoYesThe RSRS Director will contact your for more information.

Does the student have any allergies? If yes, please list them.

Do you want to OPT OUT of KAJY (3rd – 8th grades)?

Upload Proof of COVID Vaccination

We are currently requiring proof of vaccination, including a booster for those eligible (ages 12+)

Already submitted proof of COVID vaccinationChild under the age of 5

* First Name

* Last Name

Hebrew Name with Parents

If you need assistance with your Hebrew name, please contact the Rabbi at rabbi@conkolami.org and he will happily assist you.

* Preferred Pronouns

* Date of Birth

* Grade Level for 2022-2023

* Secular School District

* Secular School Name

Are there any academic, behavioral, emotional needs that may impact student’s experience at Religious School?

YesNoThe RSRS Director will contact your for more information.

Does the student have any allergies? If yes, please list them.

Do you want to OPT OUT of KAJY (3rd – 8th grades)?

Upload Proof of COVID Vaccination

We are currently requiring proof of vaccination, including a booster for those eligible (ages 12+)

Already submitted proof of COVID vaccinationChild under the age of 5

* First Name

* Last Name

Hebrew Name with Parents

If you need assistance with your Hebrew name, please contact the Rabbi at rabbi@conkolami.org and he will happily assist you.

* Preferred Pronouns

* Date of Birth

* Grade Level for 2022-2023

* Secular School District

* Secular School Name

Are there any academic, behavioral, emotional needs that may impact student’s experience at Religious School?

YesNoThe RSRS Director will contact your for more information.

Does the student have any allergies? If yes, please list them.

Do you want to OPT OUT of KAJY (3rd – 8th grades)?

Upload Proof of COVID Vaccination

We are currently requiring proof of vaccination, including a booster for those eligible (ages 12+)

Already submitted proof of COVID vaccinationChild under the age of 5

Parent Volunteer Sign Up

Parent volunteering is essential to the success of the Rafi Schwartz Religious School. It's also a great way to meet other parents and get involved at Kol Ami. For each student you have in the school, parents are asked to volunteer four hours per school year. You may donate $54 per student in lieu of volunteering. Please select all events / programs that you are interested in helping with. You will be contacted with more information. Todah Rabbah!

I would like to make a donation of $54 per student in lieu of volunteering.