2023-2024 R School Registration - Form - Congregation Rodef Shalom

You must be logged into your Congregation Rodef Shalom account to register. If you do not have an account or do not have a login, please contact us before continuing.

* Congregation Rodef Shalom (CRS) membership:

CRS MembersCRS Non-Members

* Student 1 First Name

* Student 1 Last Name

* Date of Birth

* Registration Fee

Member Tuition

Non-Member Tuition

* Current School Year Grade

Student 1 Physical or Health Needs (check all that apply)

Food/dietary restrictions or allergiesMy child has an IEP or 504 planPlease have R School's Inclusion Specialist contact me

Please provide details:

Student 2 First Name

Student 2 Last Name

Date of Birth

Registration Fee

Member Tuition

Non-Member Tuition

Current School Year Grade

Student 2 Physical or Health Needs (check all that apply)

Food/dietary restrictions or allergiesMy child has an IEP or 504 planPlease have R School's Inclusion Specialist contact me

Please provide details:

Student 3 First Name

Student 3 Last Name

Date of Birth

Registration Fee

Member Tuition

Non-Member Tuition

Current School Year Grade

Student 3 Physical or Health Needs (check all that apply)

Food/dietary restrictions or allergiesMy child has an IEP or 504 planPlease have R School's Inclusion Specialist contact me

Please provide details:

(1) Emergency Contact First & Last Name

Relationship to Child(ren)

Phone Number

(2) Emergency Contact First & Last Name

Relationship to Child(ren)

Phone Number

Physician Name

Healthcare/Hospital or Emergency Facility

Phone Number

Parent Release Items (All students are automatically opted in for items where boxes are not checked)

Emergency Release: In the event of an emergency, I DO NOT give permission to Congregation Rodef Shalom or its agent to hospitalize and/or secure proper treatment for my child(ren) as named in this form.Field Trip Release: I DO NOT authorize my child(ren), listed in this form, to leave Congregation Rodef Shalom for Field Trips with adequate supervision and advanced notice.Photo and Video Release Authorization: Photos or videos will be taken of students, student activities, etc. Names will not be used without a separate, signed release. I DO NOT authorize the use of photos or videos of my child(ren).

* Payment Options

* Autopay Schedule

Please note that if you did not choose "I will set up my payment method and schedule by September 15, 2023," please select "Bill to Account" on the payment page and we will contact you or note your account according to your Payment Options selection.