Student Interest & Needs Form
This information helps us prepare to meet individual students' needs and interests and to ensure their meaningful participation in Religious School activities
Primary Contacts
Please list the student's custodial parent/guardian(s) as well as any co- or non-custodial parent/guardian/family member who should be included on regular or emergency communications
Student Name
First Name
Last Name
Parent/Guardian 1 Phone Number
-
Area Code
Phone Number
Parent/Guardian 2 Phone Number
-
Area Code
Phone Number
Additional Parent/Guardian Phone Number
-
Area Code
Phone Number
Emergency Contacts
We will always attempt to contact the listed primary contacts first. Please provide the name and phone number of a non-parent emergency contact in case we are unable to reach you.
Emergency Contact 1:
*
First Name
Last Name
Relationship to Child
*
Phone Number
*
-
Area Code
Phone Number
Is this person allowed to pick up your child?
*
Yes, I do give permission.
No, I do not give permission
Emergency Contact 2:
First Name
Last Name
Relationship to Child
Phone Number
-
Area Code
Phone Number
Is this person allowed to pick up your child?
Yes, I do give permission.
No, I do not give permission
Photo Release Do you give Temple Sinai of Bergen County permission to use photographs or videos of your child on our public channels (social media, website) and other external communications?
*
Yes, I do give permission.
No, I do not give permission
Learning Needs and Accommodations
How does your child learn best?
What activities does your child like best?
Does your child have any specific learning differences or require additional accommodations we should be aware of?
Does your child have a current IEP (Individualized Education Program) or 504 Plan for learning or behavioral support at school?
Yes
No
If yes, please upload here:
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Would you like to schedule a meeting with Caryn to further discuss your child’s learning needs?
Yes, please contact me to schedule a meeting
No, not at this time
Does your child have ONE friend they would like to be placed with in a class or Chavurah (homeroom)?
Are there any students you prefer your child not be placed with?
Additional Information Do you wish to add any additional information that will help us best support your child's meaningful participation?
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