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KoREH Registration 2024-2025
Please verify reCaptcha before submitting the form.
KoREH 2024-2025 Registration
Parent/Guardian Information
*
Parent/Guardian # 1 First Name
*
Parent/Guardian # 1 Last Name
*
Parent/Guardian #1 Address
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code
Parent/Guardian #1 Home Number
*
Parent/Guardian #1 Cell Number
*
Parent/Guardian #1 Email
Congregation if not Kol Rinah
Parent/Guardian # 2 First Name
Parent/Guardian # 2 Last Name
Parent/Guardian #2 Address (If Different Than Parent/Guardian 1)
City
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
Parent/Guardian 2 Home Number (If Different than Parent/Guardian 1)
Parent/Guardian 2 Cell Number
Parent/Guardian 2 Email
Congregation if not Kol Rinah
If parents live apart, to whom should we send communications?
Both Parents/Guardians
Parent/Guardian # 1
Parent/Guardian # 2
Please list an emergency contact with phone number in case parent(s) are not available
Photo/Marketing Communication Release:
Throughout the school year pictures and videos are taken by staff and classroom teachers for educational and celebratory purposes. These pictures may appear in public forums which include the synagogue, school website, the Jewish Light, etc, and are most typically shared with families as email attachments or uploaded to the KoREH Facebook page.
*
Do we have your permission to include your child for these purposes?
Yes
No
Insurance Information
Insurance Carrier/Plan Name
Carrier address
Group Number
Policy Number
Claims Authorization Phone Number
Name of the Insured
Relationship to Participant
*
How many children will be attending KoREH?
Please Select One
One
Two
Three
Student # 1 Information
*
Student # 1 First Name
*
Student # 1 Last Name
Student # 1 Hebrew Name
*
Student # 1 Birthdate
*
Student # 1 Age as of Sept. 1st, 2024
*
Student # 1 Gender
Student #1 preferred pronouns
*
Student # 1 Grade at Kol Rinah as of Sept. 1, 2023
*
Student # 1 Name of Secular School
If applicable, Student #1 Personal Email
Please list any medications this student takes regularly.
If this student takes behavioral medication to attend school, is it also given on Sundays?
Yes
No
Is there any activity restriction for this student? If yes, please explain.
Please list any information that a healthcare professional will need to know about this student in the event that immediate care is needed. Please include all allergies and/or other health problems.
Student # 1 Learning Information
*
Please list any extra curricular activities that this student enjoys (camp, sports, music, etc)
*
Does this student have any learning disabilities or special needs that may affect classroom performance?
Yes
No
If yes, please explain
*
Does this student have an IEP?
Yes
No
If so, please provide the director with a copy.
*
Does this student need a special assistant in the classroom?
Yes
No
If yes, please contact the director.
Please list any other details we should know about this student.
Student # 2 Information
Student # 2 First Name
Student # 2 Last Name
Student # 2 Hebrew Name
Student # 2 Birthdate
Student # 2 Age as of Sept. 1st, 2023
Student # 2 Gender
Student #2 preferred pronouns
*
Student # 2 Grade at Kol Rinah as of Sept. 1, 2024
*
Student # 2 Name of Secular School
If applicable, Student # 2 Personal Email
Please list any medications this student takes regularly
If this student takes behavioral medication to attend school, is it also given on Sundays?
yes
no
Is there any activity restriction for this student? If yes, please explain.
Please list any information that a healthcare professional will need to know about this student in the event that immediate care is needed. Please include all allergies and/or other health problems.
Student #2 Learning Information
Please list any extra curricular activities that this student enjoys (camp, sports, music, etc)
Does this student have any learning disabilities or special needs that may affect classroom performance?
yes
no
If yes, please explain
Does this student have an IEP?
yes
no
Does this student need a special assistant in the classroom?
yes
no
Please list any other details we should know about this student
Student # 3 Information
Student # 3 First Name
Student # 3 Last Name
Student # 3 Hebrew Name
Student # 3 Birthdate
Student # 3 Age as of Sept. 1st, 2023
Student # 3 Gender
Student #3 preferred pronouns
*
Student # 3 Grade at Kol Rinah as of Sept. 1, 2023
*
Student # 3 Name of Secular School
If applicable, Student # 3 Personal Email
Please list any medications this student takes regularly.
If this student takes behavioral medication to attend school, is it also given on Sundays?
Yes
No
Is there any activity restriction for this student? If yes, please explain.
Please list any information that a healthcare professional will need to know about this student in the event that immediate care is needed. Please include all allergies and/or other health problems.
Student # 3 Learning Information
Please list any extra curricular activities that this student enjoys (camp, sports, music, etc)
Does this student have any learning disabilities or special needs that may affect classroom performance?
Yes
No
If yes, please explain
Does this student have an IEP?
Yes
No
If so, please provide the director with a copy.
Does this student need a special assistant in the classroom?
Yes
No
If yes, please contact the director.
Please list any other details we should know about this student.
Tuition Information and Payment
Fees include books, supplies, and refreshments: Early Bird Rate applies if registered before June 30th, 2024
Grade Class Time Congregant Non-Congregant Early Bird Congregant Early Bird Non-Congregant
PreK-
Sunday
$850 $1,100 $800 $1,050
1st Grade
2nd- Sunday
7th Grade
$1,200 $1,450 $1,150 $1,400
& Virtual Session
*
Congregant
0
1
2
3
4
5
6
7
8
9
10
Pre-K, K, or 1st Grade Congregant
0
1
2
3
4
5
6
7
8
9
10
Pre-K, K, or 1st Grade Non-Congregant
0
1
2
3
4
5
6
7
8
9
10
2nd, 3rd, 4th, 5th, 6th, 7th Grade Congregant
0
1
2
3
4
5
6
7
8
9
10
2nd, 3rd, 4th, 5th, 6th, 7th Grade Non-Congregant
If you have discussed a a financial adjustment with Cindy Kalachek, please enter the agreed upon amount here.
Total
Thu, May 16 2024 8 Iyyar 5784
