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Returning Students Registration
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Enroll
Returning Students Registration
Returning Student Registration Form
Page 1
Family Information
Family Name
Parent 1 Name
Parent 1 Email
Parent 2 Name
Parent 2 Email
Child Information
Number of children you would like to register
1
2
3
4
Child's Name
Grade Entering
Second Child's Name
Grade Entering
Third Child's Name
Grade Entering
Fourth Child's Name
Grade Entering
Updated Information
Verification
All existing information on file is up-to-date.
Our information has changed and the changes are listed below.
Please update the following information:
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 full
Monthly beginning August 1, 2025
Two Payments August 1, 2025 and January 1, 2026
10 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 Card
Mail 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 $:
How would you like to pay?
Credit Card
Mail Check(s) to 730 Ponce de Leon Place NE, Atlanta, GA 30306
Name on Card
Card Number
MM
YY
Code
Billing Address
Address Line 1
Address Line 2
City
State/Province
Postal 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, 2021. Enrollment 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.
R
ELEASE 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
1
2
3
4
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?
Yes
No
Please list all medications
Does your child have any allergies towards food or medication?
Yes
No
Please list all allergies
Does your child have need for an epi-pen?
Yes
No
I
f 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
Email
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?
Yes
No
Please list all medications
Does this child have any allergies towards food or medication?
Yes
No
Please list all allergies
Does this child have need for an epi-pen?
Yes
No
I
f 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
Email
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?
Yes
No
Please list all medications
Does this child have any allergies towards food or medication?
Yes
No
Please list all allergies
Does this child have need for an epi-pen?
Yes
No
I
f 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
Email
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?
Yes
No
Please list all medications
Does this child have any allergies towards food or medication?
Yes
No
Please list all allergies
Does this child have need for an epi-pen?
Yes
No
I
f 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
Email
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?
Yes
No
Please list all medications
Does this child have any allergies towards food or medication?
Yes
No
Please list all allergies
Does this child have need for an epi-pen?
Yes
No
I
f 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
Email
3rd Child's Medical Information
3rd Child's Full Name
3rd 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?
Yes
No
Please list all medications
Does your child have any allergies towards food or medication?
Yes
No
Please list all allergies
Does your child have need for an epi-pen?
Yes
No
I
f 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
Email
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?
Yes
No
Please list all medications
Does this child have any allergies towards food or medication?
Yes
No
Please list all allergies
Does this child have need for an epi-pen?
Yes
No
I
f 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
Email
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?
Yes
No
Please list all medications
Does this child have any allergies towards food or medication?
Yes
No
Please list all allergies
Does this child have need for an epi-pen?
Yes
No
I
f 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
Email
3rd Child's Medical Information
3rd Child's Full Name
3rd 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?
Yes
No
Please list all medications
Does your child have any allergies towards food or medication?
Yes
No
Please list all allergies
Does your child have need for an epi-pen?
Yes
No
I
f 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
Email
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?
Yes
No
Please list all medications
Does this child have any allergies towards food or medication?
Yes
No
Please list all allergies
Does this child have need for an epi-pen?
Yes
No
I
f 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
Email
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