2024-2025 LEC Student Registration

2025-2026 LEC Tuition Schedule

$420 - 1st student $310- 3rd student
$376- 2nd student $158 - 4th student

$250 - 2-year-olds (meet for the first 2.5 hours)
Are you a member at Congregation Ahavath Sholom?

YesNo
- Student Name*
  
  First NameHebrew nameLast Name
- Date of Birth*
  
  MonthDayYear
  Date
- Age*
- Grade Level for the school year 2025-2026
- School Name *
- Has student listed above received all required vaccinations? (does not include COVID 19)*
  
  YesNo
- Does this student have any allergies (Y/N)*
  
  YesNo
- If the student have any allergies, please list them down below
  Type N/A if none
- Does the student have any medical conditions that you would like to declare?
- Student Accommodation
  Does the student above need any accommodations? Ex.: vision, hearing, learning, or other needs
- Student Name
  
  First NameHebrew nameLast Name
- Date of Birth
  
  MonthDayYear
  Date
- Age
- Grade Level for the school year 2025-2026
- School Name
- Has student listed above received all required vaccinations? (does not include COVID 19)
  
  YesNo
- Does this student have any allergies (Y/N)
  
  YesNo
- If the student have any allergies, please list them down below
  Type N/A if none
- Does the student have any medical conditions that you would like to declare?
- Student Accommodation
  Does the student above need any accommodations? Ex.: vision, hearing, learning, or other needs
- Student Name
  
  First NameHebrew nameLast Name
- Date of Birth
  
  MonthDayYear
  Date
- Age
- Grade Level for the school year 2025-2026
- School Name
- Has student listed above received all required vaccinations? (does not include COVID 19)
  
  YesNo
- Does this student have any allergies (Y/N)
  
  YesNo
- If the student have any allergies, please list them down below
  Type N/A if none
- Does the student have any medical conditions that you would like to declare?
- Student Accommodation
  Does the student above need any accommodations? Ex.: vision, hearing, learning, or other needs
- Student Name
  
  First NameHebrew nameLast Name
- Date of Birth
  
  MonthDayYear
  Date
- Age
- Grade Level for the school year 2025-2026
- School Name
- Has student listed above received all required vaccinations? (does not include COVID 19)
  
  YesNo
- Does this student have any allergies (Y/N)
  
  YesNo
- If the student have any allergies, please list them down below
  Type N/A if none
- Does the student have any medical conditions that you would like to declare?
- Student Accommodation
  Does the student above need any accommodations? Ex.: vision, hearing, learning, or other needs
- Parent/Guardian's Name - Primary*
  First and last name
- E-mail*
- Mobile Number*
- Alternate Number
  Please enter a valid phone number.Format: (000) 000-0000.
- Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip Code
- Parent/Guardian's Name - Secondary*
  First and last name
- E-mail*
- Mobile Number*
- Alternate Number
  Please enter a valid phone number.Format: (000) 000-0000.
- In case of emergency, who will be notified? Please answer the fields below:
- Emergency Contact Person*
  First and last name
- Relationship to Student*
- Emergency Phone Number*
  Please enter a valid phone number.Format: (000) 000-0000.
- Authorized Pick-Up?*
  Other than parent(s), who may pick up your child from school? If none, enter N/A
- Medical Release: Please select one: "I agree" or "I disagree"
  
  In the event of an emergency, I hereby give qualified medical personnel permission to secure proper treatment for my child(ren), including, if necessary, hospitalization. I understand that I will be contacted immediately in such a case.
- Medical Release*
  
  I agreeI disagree
- Record of immunizations If you can't upload the file please sent it to LEC email: lec@ahavathsholom.org
  
  Cancelof
- Photo Release: Please select one: "I agree" or "I disagree"
  
  Do you allow the use of pictures of your child(ren) to appear in the following (names and other identifying information will not be used):
  
  * Learning and Engagement Center Facebook page or other publicity materials, for educational and advertising purposes
  
  * Weekly LEC newsletter, distributed to school families and select synagogue members only
  
  * Various CAS synagogue publications(monthly bulletin, weekly email, or CAS website)
- Photo Release (above)*
  
  I agreeI disagree
- Does/do your child(ren) have permission to attend field trips?
  
  YesNo
- Date Signed
  
  MonthDayYear
  Date
- Parent/Guardian Signature*
  Type your first and last name in the field above.
- Please verify that you are human*
- Should be Empty: