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2022-2023 Teen Collab Registration Form

Our teen program is expanding and has so much to offer - we hope that our teens will find at least one component that speaks to them and will participate. If there's something that feels missing, please reach out, we'd love to hear from you!
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: Teen Enrollment Information
Teen 1 Information
Information will not be shared publicly. Parents will be copied
on all communication to students.
Information will not be shared publicly. 

Are there any important educational needs that would help us support your teen's learning? If you prefer, please feel free to reach out to our Education Director, Adam Bender via email.

 

Is there anything else you would like your child’s teacher to know?
Does your teen have allergies or medications we need to know about?
Please describe allergies and medications with dosage and timing.
Teen 2 Information
Information will not be shared publicly. Parents will be copied
on all communication to teens.
Information will not be shared publicly. 

Are there any important educational needs that would help us support your teen's learning? If you prefer, please feel free to reach out to our Education Director, Adam Bender via email.

 

Is there anything else you would like your child’s teacher to know?
Does your child have allergies or medications we need to know about?
Please describe allergies and medications with dosage and timing.
Student 3 Information
Information will not be shared publicly. Parents will be copied on all communication to teens.
Information will not be shared publicly. 

Are there any important educational needs that would help us support your teen's learning? If you prefer, please feel free to reach out to our Education Director, Adam Bender via email.

 

Is there anything else you would like your teen's teacher to know?

Does your teen have allergies or medications we need to know about?
Please describe allergies and medications with dosage and timing.
Section C: Release Forms

I hereby authorize the Administrator, or person designated by the Administrator, to obtain emergency medical care for my teen(s) in the event such care is indicated. I give my permission for my teen(s) to receive emergency medical care by any nurse, doctor, paramedic or member of a medical staff of a hospital licensed by the State of New York. I understand that every effort will be made to notify a parent/guardian prior to treatment.

I certify that my teen(s) is(are) in good physical health and up to date on vaccinations.

By typing my name, I confirm I have read, understand and agree to the above.
Media Release
Section F: Payment Information
There are many impediments to Jewish education but finances should never be one. 
We ask that every family commits to some financial contribution, however we are very happy to discuss financial aid options for any dues paying family that may require tuition assistance.
If you select yes, you will discuss your payment ability in a confidential meeting with the PJC Treasurer.
Please contact Mitch Cepler: mcepler@gmail.com.

Mon, October 3 2022 8 Tishrei 5783