Midrasha (Hebrew High School)

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The cost of this new program is $540 for the year. Please register below!

* student's first name

* student's last name

* student's date of birth

* student's primary address

* Student's grade level in Sept. 2023

8th9th

Name of school student will attend for 2023-2024

* Please list any allergies your child has. What is the typical reaction and treatment? If none, write NONE

Any special learning needs/IEP/Social strategies/etc.?

student email

* Parent/Guardian full name

* Parent/Guardian cell phone #

* Parent/Guardian email address

* Emergency contact name and number

* Photographs and video images of students in the EBJC education and youth programs are routinely taken for the purpose of celebrating student achievement and sharing educational programs with the community. Photographs may be submitted to area newspapers. Video footage may be submitted to area news outlets that cover special events that occur in the area or posted to websites. Please check 1 box below.

I GRANT permissionI DO NOT GRANT permission

* PARENT'S AUTHORIZATION AND PERMISSION TO PROVIDE EMERGENCY CARE: My typed name below indicates my agreement with the following: To the best of my knowledge, the medical history is correct and complete. I know of no reason to restrict the participant's activity and hereby give my permission for participation in all activities except as specifically noted herein. In the event that I cannot be reached in an emergency, I hereby give permission to the medical personnel selected by the East Brunswick Jewish Center to order x-rays, routine tests, treatment, and transportation for my child. I also hereby give permission to the physician selected by EBJC to secure and administer treatment, including hospitalization, for the persons named above.

total amount due

Sat, July 27 2024 21 Tammuz 5784