New Student Registration Form

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New Student Registration Form

New Student Application Form

Page 1

Family Information

Family Name

Phone

Address Line 1

Address Line 2

City

State

Postal Code

Parent 1 Name

Parent 1 Hebrew Name (if available)

Parent 1 Email

Parent 1 Cell Phone

Parent 1 Address is the SAME as the Address Above?

Yes

Address Line 1

Address Line 2

City

State

State/Province

Postal Code

Parent 1 is

Jewish by Birth

Jewish by Choice

Not Jewish

Please explain.

Parent 2 Name

Parent 2 Hebrew Name (if available)

Parent 2 Email

Parent 2 Cell Phone

Parent 2 Address is the SAME as the Address Above?

Yes

Address Line 1

Address Line 2

City

State

State/Province

Postal Code

Parent 2 is

Jewish by Birth

Jewish by Choice

Not Jewish

Please explain.

Marital Status of Parents

Does someone other than the parent(s) care for your child(ren)?

NoYes

Name

Phone

Child Information

Number of children you would like to register

Child's Name

Child's Hebrew Name

Child's DOB

Child's Hebrew DOB (if not known, please indicate time of birth)

Child's Current School

Grade Entering

Please tell us about your child, strengths, weaknesses, disposition and anything else that will help us best serve your child.

Second Child's Name

Second Child's Hebrew Name

Second Child's DOB

Second Child's Hebrew DOB (if not known, please indicate time of birth)

Second Child's Current School

Grade Entering

Please tell us about your child, strengths, weaknesses, disposition and anything else that will help us best serve your child.

Third Child's Name

Third Child's Hebrew Name

Third Child's DOB

Third Child's Hebrew DOB (if not known, please indicate time of birth)

Third Child's Current School

Grade Entering

Please tell us about your child, strengths, weaknesses, disposition and anything else that will help us best serve your child.

Fourth Child's Name

Fourth Child's Hebrew Name

Fourth Child's DOB

Fourth Child's Hebrew DOB (if not known, please indicate time of birth)

Fourth Child's Current School

Grade Entering

Please tell us about your child, strengths, weaknesses, disposition and anything else that will help us best serve your child.

Tuition & Payment

Tuition costs $1,200 per child.

In the interest of increased security for the Intown Hebrew School, IHS provides a security officer during the hours of Hebrew School drop off and pick up. Each family is required to pay the $100 security fee. We will bill for this separately.

Select a payment plan

Pay in fullMonthly beginning August 1, 2025Two Payments August 1, 2025 and January 1, 202610 Equal payments beginning August 1, 2025

When do you want to pay for the $100 Security Fee?

Now.Bill me later.

Total Tuition Fee $:

How would you like to pay?

Credit CardMail Check(s) to 730 Ponce de Leon Place NE, Atlanta, GA 30306

Total Tuition Fee $:

Registration is complete upon payment of a $100 non-refundable fee, which will be applied toward your total tuition balance.

Total Deposit Fee $:

Discount Code

Discount Amount

Total Registration

How would you like to pay?

Credit CardMail Check(s) to 730 Ponce de Leon Place NE, Atlanta, GA 30306

Name on Card

Card Number

Code

Page 2

To enroll your child(ren) in Intown Hebrew School, all forms must be completed and sent in to the school. Your application will not be processed without the required forms and fees.

Full payment, or the first payment in the case of a payment plan, is due at the beginning of the school year, August 1, 2025. Enrolment is considered to be for the entire scholastic year. There will be no refunds even if the child is absent due to illness, holidays, vacations and snow days, or should the parents decide to withdraw the child from the program.

In the event that tuition is not paid, IHS reserves the right to debit your Credit/Debit card, plus a $25 processing fee.

RELEASE OF INFORMATION AND PHOTOGRAPHS: Parents allow for child(ren)'s picture to be used for internal PR mailing and website where name is not given. Parents allow for child(ren)'s photograph/name released to newspapers where last name will not be given. If not, please contact us.MEDICAL RELEASE: As the parent(s) or legal guardian of the above child/ren, I/we authorize any adult acting on behalf of Intown Hebrew School to hospitalize or secure treatment for my child, I further agree to pay all charges for that care and/or treatment. It is understood that if time and circumstances reasonably permit, Intown Hebrew School personnel will try, but are not required, to communicate with me prior to such treatment.TRIPS AND OUTINGS RELEASE: I hereby give permission for my child to attend and participate in all trips and outings organised as part of the program by Intown Hebrew School.PRIVACY RELEASE: I hereby give permission for my child’s photographs/videos to be used in newsletters, local newspapers, Intown Hebrew School website or for promotion of our program.DISPOSITION: Parent acknowledges that Intown Hebrew School serves children who are able to function successfully in a group setting. If, in the judgment of the school's Director, the child is not able to function in a group setting, the parent may be asked to withdraw the child. In the event that the parent is request to withdraw the child, the Director will work with the parent to identify possible alternative programs suitable for the child.

By submitting and initialing this form, parents accept the terms outlined above. Both parents must initial.

Mother's Initials

Date

Father's Initials

Date

Authnet_Hidden_Fields

Page 3

Medical Information

Number of children you would like to submit medical information for

1234

Child's Medical Information

Child's Full Name

Child's Date of Birth

Medical and Developmental History

Does your child have any medical, developmental or behavioral issue that we should know about? Describe:

Does your child take any medications on a regular basis?

YesNo

Please list all medications

Does your child have any allergies towards food or medication?

YesNo

Please list all allergies

Does your child have need for an epi-pen?

YesNo

If yes, please provide a current epi-pen and written permission to administer to Intown Hebrew School at the beginning of the school year.

Medical Emergencies

Authorization

I authorize the director or director's designee to seek appropriate medical care for my child, if necessary.

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

Emergency Contact #1:

First Name

Last Name

Phone Number

Relationship to Student

Emergency Contact #2:

First Name

Last Name

Phone Number

Relationship to Student

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

Doctor

Phone Number

Address

Hospital Affiliation

In case of medical emergency requiring immediate emergency care, I authorize the paramedics to take my child to the nearest hospital if necessary. It is understood that I will hold IHS harmless for the nature and outcome of any emergency medical treatment. It is also understood that I leave the decision of what constitutes an emergency to the sole direction of the staff (please sign):

Mother's Initials

Date

Father's Initials

Date

Prove you are a human 🙂 What is 5+5+8?

2 Children's Medical Information

1st Child's Full Name

1st Child's Date of Birth

Medical and Developmental History

Does this child have any medical, developmental or behavioral issue that we should know about? Describe:

Does this child take any medications on a regular basis?

YesNo

Please list all medications

Does this child have any allergies towards food or medication?

YesNo

Please list all allergies

Does this child have need for an epi-pen?

YesNo

If yes, please provide a current epi-pen and written permission to administer to Intown Hebrew School at the beginning of the school year.

Medical Emergencies

Authorization

I authorize the director or director's designee to seek appropriate medical care for this child, if necessary.

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

Emergency Contact #1:

First Name

Last Name

Phone Number

Relationship to Student

Emergency Contact #2:

First Name

Last Name

Phone Number

Relationship to Student

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

Doctor

Phone Number

Address

Hospital Affiliation

In case of medical emergency requiring immediate emergency care, I authorize the paramedics to take my child to the nearest hospital if necessary. It is understood that I will hold IHS harmless for the nature and outcome of any emergency medical treatment. It is also understood that I leave the decision of what constitutes an emergency to the sole direction of the staff (please sign):

Mother's Initials

Date

Father's Initials

Date

2nd Child's Medical Information

2nd Child's Full Name

2nd Child's Date of Birth

Medical and Developmental History

Does this child have any medical, developmental or behavioral issue that we should know about? Describe:

Does this child take any medications on a regular basis?

YesNo

Please list all medications

Does this child have any allergies towards food or medication?

YesNo

Please list all allergies

Does this child have need for an epi-pen?

YesNo

If yes, please provide a current epi-pen and written permission to administer to Intown Hebrew School at the beginning of the school year.

Medical Emergencies

Authorization

I authorize the director or director's designee to seek appropriate medical care for my child, if necessary.

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

Emergency Contact #1:

First Name

Last Name

Phone Number

Relationship to Student

Emergency Contact #2:

First Name

Last Name

Phone Number

Relationship to Student

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

Doctor

Phone Number

Address

Hospital Affiliation

In case of medical emergency requiring immediate emergency care, I authorize the paramedics to take my child to the nearest hospital if necessary. It is understood that I will hold IHS harmless for the nature and outcome of any emergency medical treatment. It is also understood that I leave the decision of what constitutes an emergency to the sole direction of the staff (please sign):

Mother's Initials

Date

Father's Initials

Date

Prove you are a human 🙂 What is 5+5+8?

3 Children's Medical Information

1st Child's Full Name

1st Child's Date of Birth

Medical and Developmental History

Does this child have any medical, developmental or behavioral issue that we should know about? Describe:

Does this child take any medications on a regular basis?

YesNo

Please list all medications

Does this child have any allergies towards food or medication?

YesNo

Please list all allergies

Does this child have need for an epi-pen?

YesNo

If yes, please provide a current epi-pen and written permission to administer to Intown Hebrew School at the beginning of the school year.

Medical Emergencies

Authorization

I authorize the director or director's designee to seek appropriate medical care for this child, if necessary.

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

Emergency Contact #1:

First Name

Last Name

Phone Number

Relationship to Student

Emergency Contact #2:

First Name

Last Name

Phone Number

Relationship to Student

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

Doctor

Phone Number

Address

Hospital Affiliation

In case of medical emergency requiring immediate emergency care, I authorize the paramedics to take my child to the nearest hospital if necessary. It is understood that I will hold IHS harmless for the nature and outcome of any emergency medical treatment. It is also understood that I leave the decision of what constitutes an emergency to the sole direction of the staff (please sign):

Mother's Initials

Date

Father's Initials

Date

2nd Child's Medical Information

2nd Child's Full Name

2nd Child's Date of Birth

Medical and Developmental History

Does this child have any medical, developmental or behavioral issue that we should know about? Describe:

Does this child take any medications on a regular basis?

YesNo

Please list all medications

Does this child have any allergies towards food or medication?

YesNo

Please list all allergies

Does this child have need for an epi-pen?

YesNo

If yes, please provide a current epi-pen and written permission to administer to Intown Hebrew School at the beginning of the school year.

Medical Emergencies

Authorization

I authorize the director or director's designee to seek appropriate medical care for my child, if necessary.

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

Emergency Contact #1:

First Name

Last Name

Phone Number

Relationship to Student

Emergency Contact #2:

First Name

Last Name

Phone Number

Relationship to Student

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

Doctor

Phone Number

Address

Hospital Affiliation

In case of medical emergency requiring immediate emergency care, I authorize the paramedics to take my child to the nearest hospital if necessary. It is understood that I will hold IHS harmless for the nature and outcome of any emergency medical treatment. It is also understood that I leave the decision of what constitutes an emergency to the sole direction of the staff (please sign):

Mother's Initials

Date

Father's Initials

Date

3rd Child's Medical Information

3rd Child's Full Name

3rd Child's Date of Birth

Medical and Developmental History

Does this child have any medical, developmental or behavioral issue that we should know about? Describe:

Does this child take any medications on a regular basis?

YesNo

Please list all medications

Does this child have any allergies towards food or medication?

YesNo

Please list all allergies

Does this child have need for an epi-pen?

YesNo

If yes, please provide a current epi-pen and written permission to administer to Intown Hebrew School at the beginning of the school year.

Medical Emergencies

Authorization

I authorize the director or director's designee to seek appropriate medical care for this child, if necessary.

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

Emergency Contact #1:

First Name

Last Name

Phone Number

Relationship to Student

Emergency Contact #2:

First Name

Last Name

Phone Number

Relationship to Student

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

Doctor

Phone Number

Address

Hospital Affiliation

In case of medical emergency requiring immediate emergency care, I authorize the paramedics to take my child to the nearest hospital if necessary. It is understood that I will hold IHS harmless for the nature and outcome of any emergency medical treatment. It is also understood that I leave the decision of what constitutes an emergency to the sole direction of the staff (please sign):

Mother's Initials

Date

Father's Initials

Date

Prove you are a human 🙂 What is 5+5+8?

4 Children's Medical Information

1st Child's Full Name

1st Child's Date of Birth

Medical and Developmental History

Does this child have any medical, developmental or behavioral issue that we should know about? Describe:

Does this child take any medications on a regular basis?

YesNo

Please list all medications

Does this child have any allergies towards food or medication?

YesNo

Please list all allergies

Does this child have need for an epi-pen?

YesNo

If yes, please provide a current epi-pen and written permission to administer to Intown Hebrew School at the beginning of the school year.

Medical Emergencies

Authorization

I authorize the director or director's designee to seek appropriate medical care for this child, if necessary.

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

Emergency Contact #1:

First Name

Last Name

Phone Number

Relationship to Student

Emergency Contact #2:

First Name

Last Name

Phone Number

Relationship to Student

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

Doctor

Phone Number

Address

Hospital Affiliation

In case of medical emergency requiring immediate emergency care, I authorize the paramedics to take my child to the nearest hospital if necessary. It is understood that I will hold IHS harmless for the nature and outcome of any emergency medical treatment. It is also understood that I leave the decision of what constitutes an emergency to the sole direction of the staff (please sign):

Mother's Initials

Date

Father's Initials

Date

2nd Child's Medical Information

2nd Child's Full Name

2nd Child's Date of Birth

Medical and Developmental History

Does this child have any medical, developmental or behavioral issue that we should know about? Describe:

Does this child take any medications on a regular basis?

YesNo

Please list all medications

Does this child have any allergies towards food or medication?

YesNo

Please list all allergies

Does this child have need for an epi-pen?

YesNo

If yes, please provide a current epi-pen and written permission to administer to Intown Hebrew School at the beginning of the school year.

Medical Emergencies

Authorization

I authorize the director or director's designee to seek appropriate medical care for my child, if necessary.

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

Emergency Contact #1:

First Name

Last Name

Phone Number

Relationship to Student

Emergency Contact #2:

First Name

Last Name

Phone Number

Relationship to Student

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

Doctor

Phone Number

Address

Hospital Affiliation

In case of medical emergency requiring immediate emergency care, I authorize the paramedics to take my child to the nearest hospital if necessary. It is understood that I will hold IHS harmless for the nature and outcome of any emergency medical treatment. It is also understood that I leave the decision of what constitutes an emergency to the sole direction of the staff (please sign):

Mother's Initials

Date

Father's Initials

Date

3rd Child's Medical Information

3rd Child's Full Name

3rd Child's Date of Birth

Medical and Developmental History

Does this child have any medical, developmental or behavioral issue that we should know about? Describe:

Does this child take any medications on a regular basis?

YesNo

Please list all medications

Does this child have any allergies towards food or medication?

YesNo

Please list all allergies

Does this child have need for an epi-pen?

YesNo

If yes, please provide a current epi-pen and written permission to administer to Intown Hebrew School at the beginning of the school year.

Medical Emergencies

Authorization

I authorize the director or director's designee to seek appropriate medical care for this child, if necessary.

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

Emergency Contact #1:

First Name

Last Name

Phone Number

Relationship to Student

Emergency Contact #2:

First Name

Last Name

Phone Number

Relationship to Student

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

Doctor

Phone Number

Address

Hospital Affiliation

In case of medical emergency requiring immediate emergency care, I authorize the paramedics to take my child to the nearest hospital if necessary. It is understood that I will hold IHS harmless for the nature and outcome of any emergency medical treatment. It is also understood that I leave the decision of what constitutes an emergency to the sole direction of the staff (please sign):

Mother's Initials

Date

Father's Initials

Date

4th Child's Medical Information

4th Child's Full Name

4th Child's Date of Birth

Medical and Developmental History

Does this child have any medical, developmental or behavioral issue that we should know about? Describe:

Does this child take any medications on a regular basis?

YesNo

Please list all medications

Does this child have any allergies towards food or medication?

YesNo

Please list all allergies

Does this child have need for an epi-pen?

YesNo

If yes, please provide a current epi-pen and written permission to administer to Intown Hebrew School at the beginning of the school year.

Medical Emergencies

Authorization

I authorize the director or director's designee to seek appropriate medical care for this child, if necessary.

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

Emergency Contact #1:

First Name

Last Name

Phone Number

Relationship to Student

Emergency Contact #2:

First Name

Last Name

Phone Number

Relationship to Student

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

Doctor

Phone Number

Address

Hospital Affiliation

In case of medical emergency requiring immediate emergency care, I authorize the paramedics to take my child to the nearest hospital if necessary. It is understood that I will hold IHS harmless for the nature and outcome of any emergency medical treatment. It is also understood that I leave the decision of what constitutes an emergency to the sole direction of the staff (please sign):

Mother's Initials

Date

Father's Initials

Date

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Page 1

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Page 3

Medical Information

Medical and Developmental History

Medical Emergencies

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

Medical and Developmental History

Medical Emergencies

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

2nd Child's Medical Information

Medical and Developmental History

Medical Emergencies

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

Medical and Developmental History

Medical Emergencies

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

2nd Child's Medical Information

Medical and Developmental History

Medical Emergencies

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

3rd Child's Medical Information

Medical and Developmental History

Medical Emergencies

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

Medical and Developmental History

Medical Emergencies

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

2nd Child's Medical Information

Medical and Developmental History

Medical Emergencies

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

3rd Child's Medical Information

Medical and Developmental History

Medical Emergencies

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

Medical and Developmental History

Medical Emergencies

In case of emergency, when neither parent can be reached, give names of two people who will take responsibility for your child:

If parents cannot be reached and emergency medical advice is needed, permission is given to the Intown Hebrew School staff to phone my child's doctor:

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