Religious School registration for the upcoming year 5775-5776 / 2015-2026 has begun.
Please access the form (below) & return as indicated at your earliest convenience.
The form can be found at the following link:
Or it is reproduced below:
Martha’s Vineyard Hebrew Center – P.O. Box 692 Vineyard Haven, MA 02568
School Application 2015-16
Child’s Name _________________________________
Date of birth __________________________
Hebrew name: ______________________________
Parent(s) names: ___________________________________________________________________________________________
Parent mailing address: _________________________________________________________________________________________________
Parent phone # _______________________________________________
Returning student? Y/N
Secular school as of September 2015 _____________ School grade: _________________
If parents/guardian live apart to whom should we send mail & email?
Does your child have any special learning needs (e.g.) ADD, ADHD, speech, language or hearing issues; dyslexia; developmental delays? If yes, please explain
(remember this documents is confidential) ___________________________________________________________________________________
Does your child have an IEP? ___________________________________________________
Please provide additional information about your child that you would like the staff and teachers to know (e.g. temperament, strengths, friendships, learning style):
Does your child have any medical conditions, or emotional or familial issues or concerns of which we should be aware? Please include allergies to medication, food or the environment.
Does your child use any of the following:
Epipen or oral medication for hives or allergies Y/N, Asthma inhaler Y/N, Diabetes medication Y/N, Other _______________________________________
Child’s physician and telephone number: ______________________________________________________________________
In case of emergency if the parent is not able to be contacted the following person is to be notified, provide name and telephone # and relationship: __________________________
Emergency contact person #2: _____________________________________________________
Parent Permission to seek treatment: I hereby give my permission to the MVHC Director or staff member in charge to take whatever steps may be necessary to obtain
emergency medical care for my child, if warranted
Parent Medical Treatment Release: In the event that I am unable to be contacted and emergency treatment is found to be necessary, I hereby authorize a physician, or such assistant as may be selected by him/her, to render temporary medical treatment to my child. I understand that I will be responsible for any related expenses. I further agree to release MVHC and its employees, officers and agents from any and all claims,
liabilities and damages arising out of such medical treatment
Photographic/Video Release Y/N
Students are expected to maintain appropriate behavior and decorum during instructional time and Shabbat services. Please help us by discussing proper synagogue behavior with your children.
In order to show respect for our synagogue please dress appropriately during Shabbat services. No jeans, please.
I hereby grant MVHC Religious School permission for my child to participate in field trips Y/N
Please provide name of health insurance company and policy #: _____________________________________________________________________________________
I know that as a part of the registration of my child in the MVHC Religious School my child must attend services at the synagogue as required by the school handbook (7th graders three times per month,
two on Shabbat morning; 5th and 6th graders two times per month, 3rd and 4th graders once per month)
I am aware that the attendance policy permits a maximum of three unexcused absences
Tuition & Fee Schedule 2015-2016:
1st student $600.00 plus $30 snack fee
2nd student $500.00 plus $30 snack fee
Grades 4-6 $20.00 materials fee
PLEASE PRINT & COMPLETE THEN RETURN TO THE OFFICE BY MAIL OR FAX (508-693-1350)