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2022-2023 Polsky Religious School Registration

Section A: Family Contact Information

If there is a secondary contact, all emails and mailings will go to both contacts. In case of urgent need, the primary contact will be notified first.

Section B: Student Enrollment Information
There can sometimes be obstacles to Jewish education, but finances should never be one! If you select yes, you will need to contact Richard Simon at kcrufus@gmail.com and complete our 2022-2023 Scholarship Form by the August 5th deadline. It can be found HERE.
Student 1 Information
This is the same as your child's grade for the 2022-2023 secular school year unless you have made other arrangements with the religious school office.
This is the same as your child's grade for the 2022-2023 secular school year unless you have made other arrangements with the religious school office.
Information will not be shared publicly. Parents will be copied on all communication to students.
Information will not be shared publicly. Students will not be contacted independently from parents.
At Congregation Beth Shalom we strive to establish an environment in which all types of learners may thrive.  Information you provide about your child’s learning strengths and challenges will assist in our efforts to accommodate and provide for those needs. Any information you provide will be held in the strictest confidence and will be shared only as necessary to provide your child with a quality educational experience.
If yes, Civia White would love to meet with you and your child’s teacher before the school year begins so that we are able to discuss the best ways to support your child from the outset.  If you are comfortable we invite you to send any documentation ahead of time to cwhite@bethshalomkc.org
Does your child take any medications, have any illness or chronic condition that school personnel needs to be aware of (i.e., asthma, dietary restrictions, allergies, ADD/ADHD, hearing, vision, speech)?
If you answered yes on the question prior, please describe. 
Please note: Congregation Beth Shalom cannot be responsible for administering any daily medications to any student. Please administer your child's medication at home, before your child comes to school. If you child has severe allergies, please supply any needed  rescue medications. Parents will receive a phone call if their child requests any over the counter pain medications. 
Feel free to share any special interests, talents, struggles, aversions, or pieces of relevant personal history that you feel might be relevant and that you ae comfortable sharing.
Student 2 Information
This is the same as your child's grade for the 2022-2023 secular school year unless you have made other arrangements with the religious school office.
This is the same as your child's grade for the 2022-2023 secular school year unless you have made other arrangements with the religious school office.
Information will not be shared publicly. Parents will be copied on all communication to students.
Information will not be shared publicly. Students will not be contacted independently from parents.
If yes, Civia White would love to sit down with you and your child’s teacher before the school year begins so that we are able to discuss the best ways to support your child from the outset.  If you are comfortable we invite you to send any documentation ahead of time to cwhite@bethshalomkc.org
Does your child take any medications, have any illness or chronic condition that school personnel needs to be aware of (i.e., asthma, dietary restrictions, allergies, ADD/ADHD, hearing, vision, speech)?
If you answered yes on the prior question, please describe. 
Student 3 Information
This is the same as your child's grade for the 2022-2023 secular school year unless you have made other arrangements with the religious school office.
This is the same as your child's grade for the 2022-2023 secular school year unless you have made other arrangements with the religious school office.
Information will not be shared publicly. Parents will be copied on all communication to students.
Information will not be shared publicly. Students will not be contacted independently from parents.
If yes, Civia White would love to sit down with you and your child’s teacher before the school year begins so that we are able to discuss the best ways to support your child from the outset.  If you are comfortable we invite you to send any documentation ahead of time to cwhite@bethshalomkc.org
Does your child take any medications, have any illness or chronic condition that school personnel needs to be aware of (i.e., asthma, dietary restrictions, allergies, ADD/ADHD, hearing, vision, speech)?
If you answered yes on the prior question, please describe.
Student 4 Information
This is the same as your child's grade for the 2022-2023 secular school year unless you have made other arrangements with the religious school office.
This is the same as your child's grade for the 2022-2023 secular school year unless you have made other arrangements with the religious school office.
Information will not be shared publicly. Parents will be copied on all communication to students.
Information will not be shared publicly. Students will not be contacted independently from parents.
If yes, Civia White would love to sit down with you and your child’s teacher before the school year begins so that we are able to discuss the best ways to support your child from the outset.  If you are comfortable we invite you to send any documentation ahead of time to cwhite@bethshalomkc.org.
Does your child take any medications, have any illness or chronic condition that school personnel needs to be aware of (i.e., asthma, dietary restrictions, allergies, ADD/ADHD, hearing, vision, speech)?
If you answered yes on the prior question, please describe.
Section C: Release Forms

By signing my name below, my child(ren) have permission to participate in the Polsky Religious School of Congregation Beth Shalom. I hereby authorize the Education Director, or person designated by the Education Director, to obtain emergency medical care for my child(ren) in the event such care is indicated. I give my permission for my child(ren) to receive emergency medical care by any nurse, doctor, paramedic or member of a medical staff of a hospital licensed by the state of Kansas. I understand that every effort will be made to notify a parent/guardian prior to treatment.

I certify that my child(ren) is(are) in good physical health. They have my permission to participate in all activities that are part of the regular religious school program.

By typing my name, I confirm I have read, understand and agree to the above.
Media Release

From time to time your child(ren)’s photo may be taken in our classrooms or special events.  We use these photos on the synagogue website, on our synagogue display boards, in the weekly Connect email, the monthly Scroll newsletter, as well as our Facebook page and other publicity materials.

This year we plan on creating a 2022-2023 Polsky Religious School Directory, which will be distributed to the parents. This information will include the students name, parents names, emails, and a primary phone number. 
Section D: Congregation Community
Please let us know below, if you would like to be involved as a parent volunteer and community member.
Section E: Payment Information

 You have requested financial assistance. Check the box below. To obtain assistance you will be need to contact Richard Simon at kcrufus@gmail.com and complete our 2022-2023 Scholarship Form. It can be found HERE.

Fri, October 7 2022 12 Tishrei 5783