Dor Hadash Registration 2025-26

Dor Hadash Registration

2025-2026 school year
Child/Family Information
Child's Name*

First NameLast Name
Child's Pronouns
Hebrew Name (if one given)
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Date of Birth*
School Grade as of September 2025*
Would you like to add a second child?*

YesNo
Second Child's Name*

First NameLast Name
Second Child's Pronouns
Second Child's Hebrew Name (if one given)
Second Child's Date of Birth*
Second Child's School Grade as of September 2025*
Would you like to add a third child?*

YesNo
Third Child's Name*

First NameLast Name
Third Child's Pronouns
Third Child's Hebrew Name (if one given)
Third Child's Date of Birth*
Third Child's School Grade as of September 2025*
Please include any information we should know about your child(ren)'s Hebrew level here.
Family Information
Parent/Guardian 1 Name*

First NameLast Name
Relationship to child*
Phone Number*
Please enter a valid phone number.
Email*
example@example.com
Address (if different than child's)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Parent/Guardian 2 Name

First NameLast Name
Relationship to Child
Phone Number
Please enter a valid phone number.
Email
example@example.com
Address (if different than child's)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Please specify any family arrangements that you would like us to know about
CONSENT FOR RELEASE OF PHOTOGRAPHS PRINT MATERIAL AND ELECTRONIC MEDIA
I hereby grant permission for my child or family to be photographed, recorded, videotaped or interviewed by Dor Hadash, Downtown Synagogue, and Repair the World, or any other of its authorized agents. I hereby consent to the publication or broadcasting of said material on a website or any other medium and any other use of said material for any educational or promotional purpose as Dor Hadash, and those acting pursuant to its authority, deem appropriate. In addition, intending to be legally bound, I, for myself, my heirs, executors and adminisrators, release Dor Hadash and any parties acting on its behalf and with its approval, from liability for use of my child's or family's images or words.
Parent/Guardian Signature

Clear
Date of Consent

MonthDayYear
Date
EMERGENCY AND MEDICAL INFORMATION

For emergencies, please indicate a contact other than parent/guardian previously listed:
Emergency Contact #1*

First NameLast Name
Relationship to Child *
Phone Number*
Please enter a valid phone number.
Emergency Contact #2

First NameLast Name
Relationship to Child
Phone Number
Please enter a valid phone number.
Allergies for first child (enter none if appropriate)*
Second child's allergies*
Third child's allergies*
Additional medical information you'd like us to know
In case of injury or illness while your child is at Dor Hadash, every effort will be made to contact the Parent/Guardian or designated emergency contacts. The following instructions will remain in force for the current academic year unless revoked in writing by the Parent/Guardian:

I give permission to the staff at Dor Hadash to administer first aid to my child when they are in attendance during Dor Hadash or Dor Hadash events. In case of a medical emergency, I authorize the staff at Dor Hadash to obtain emergency medical and/or emergency surgical treatment for my child if I am not present.
Parent/Guardian Signature*

Clear
Date of Consent*

MonthDayYear
Date
Educational Information
At Dor Hadash, we strive to establish an enivroment in which all types of learners may thrive. Information you provide about your child's learning strenths and challenges will assist in our efforts to accommodate and provide for those needs:
Please tell us about any special considerations your child(ren) may need while at Dor Hadash, specify each child by name if you have more than one enrolled!
All information will be held in confidence, shared only as reasonably necessary to provide a quality educational experience for your child. If you would prefer to discuss any of the above personally with Nicole Ellefson, the Director, please contact her at ellefson@downtownsynagogue.org or at (517) 449-3341.
Tuition for Dor Hadash for the 2025-26 school year is $850 for one child, and $650 for each additional child in the same family. Our sessions will now include Hebrew as part of our 10am-noon programming!

We don't want the cost of the program to be prohibitive for any family or child. If you need assistance please reach out to Nicole directly at ellefson@downtownsynagogue.org.

If you are able to support a family with financial need, we always accept additional donations to the program.

Payment can be made by debit or credit card, check or Stripe.

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Dor Hadash Registration

Child/Family Information

Family Information

CONSENT FOR RELEASE OF PHOTOGRAPHS PRINT MATERIAL AND ELECTRONIC MEDIA

EMERGENCY AND MEDICAL INFORMATION

Educational Information