CBS Religious School Registration - Form - Congregation Beth Shalom Napa Valley

* parent email

Please fill this form out for each child.

Student Information

* Last Name

* First Name

* Gender

Please Select OneFemaleMale

Birthday

* Grade in Fall of 2018

Hebrew Name

* Day/Secular School:

Student's Email Address:

If applicable. Parents will be copied on any emails sent directly to students.

Student's Cell Number

Emergency Contact Information

Persons other than parents/guardians authorized to pick up child from school: please list each person's name and primary phone number

* Contact #1 Name

* Conact #1 Phone Number

* Contact #2 Name

* Conact #2 Phone Number

Medical Information

* Physician Name

* Physician Phone Number

* Dentist Name

* Dentist Phone Number

* Medical Insurance Company

* Medical Insurance Policy Number

* Allergies

Please list any allergies your child has, If none, list "N/A"

* Medications

Please list any medications your child is taking and the frequency, If none, list "N/A"

* What are your goals for your child's Jewish education this year?

Does your child receive any special services in secular/day school? Does your child have an IEP or 504 plan?

Please explain any accommodations your child receives.

Have there been any recent changes in home or school life that might affect your child's learning and engagement in Religious School?

Is there anything else you would like us to know about your child?

Parent Information

* You only need to fill out this section for one child

Parent #1

* Last Name:

* First Name

* Street Address

* City:

Zip Code:

* Cell Phone:

Home Phone:

* Email Address:

Work Phone:

* Religious Affiliation

Parent #2

Last Name:

First Name

Street Address

City:

Zip Code:

Home Phone:

Cell Phone:

Work Phone:

Email Address:

Religious Affiliation

Volunteer

You only need to fill out this section for one child.

The Religious School at CBS needs your help! Jewish holiday celebrations are an important part your child’s learning experience. During class, the students learn the rituals, prayers, and meaning of the holidays. It’s after class that we come together as a community to celebrate with our children. These special events are organized and facilitated by the parents of the Religious School students.

Please pick one event from the list below to help plan and two other events to assist with on the day of the event. Parents new to our school, don’t worry, you will have the support and guidance of the parents of the older students. Veteran parents, we rely on your wisdom and expertise. We couldn’t do it without you!

* I will help plan:

Please Select One1st Day of Sunday School Picnic and Swim Party (CBS will not be providing lunch. Parents please pack a lunch for each child.)Sukkot ChanukahTu B’shevat Tree PlantingPurim CarnivalPassover CelebrationEnd of the Year at Diamond Creek

I would like to help plan this event with:

I will assist with (please select at least two events)

1st Day of Sunday School Picnic and Swim Party (CBS will not be providing lunch. Parents please pack a lunch for each child.)Sukkot ChanukahTu B’shevat Tree PlantingPurim CarnivalPassover CelebrationEnd of the Year at Diamond Creek

Total Due

Method of Payment

You have the option to pay by check or by Credit Card.

If your are paying by check, please submit your check to the CBS office. You will be receiving a statement by mail.

* Payment Option

Please Select OneCheck (bill to account)Credit Card (through PayPal)