2022-2023 After School Registration

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Join us at Or Zarua this fall!

Contact Sigal Hirsch, shirsch@orzarua.org, with any questions or issues with registration.

Please note, the form will not save if you do not complete it, so be sure to submit the form and subsequent payment information before closing the window.

If you need technical support with registration, please contact Helene Santo, hsanto@orzarua.org.

For more information about the program, click HERE.

Parent Information

Parent 1

* Parent 1 - First Name

* Parent 1 - Last Name

* Parent 1 - Cell Phone

* Parent 1 - Email

* Parent 1 - Home Address

* Parent 1 - City

* Parent 1 - State

* Parent 1 - Zip Code

Parent 1 - Occupation

Parent 1 - Business Name

Parent 1 - Work Address

Parent 1 - Work Phone

Parent 1 - Work Email

* Is there a second parent on the account?

Parent 2

* Parent 2 - First Name

* Parent 2 - Last Name

* Parent 2 - Cell Phone

* Parent 2 - Email

Does parent 2 live at the same address as parent 1?

* Parent 2 - Home Address

* Parent 2 - City

* Parent 2 - State

* Parent 2 - Zip Code

Parent 2 - Occupation

Parent 2 - Business Name

Parent 2 - Work Address

Parent 2 - Work Phone

Parent 2 - Work Email

* Marital Status

Student Information

Please make sure to fill out all fields of information on this enrollment form, so Or Zarua and its professional Hebrew School staff may best serve the needs of your child.

Student 1

* Student 1 - First Name

* Student 1 - Last Name

Student 1 - Nick Name

* Student 1 - Hebrew Name

* Student 1 - Birth Date

Student 1 - Email

* Student 1 - School

After School Choice

Student 1 - Please list any information about your child that the teachers should be aware of (i.e. any specific strengths your child might have, preferred learning style, challenges):

Allergies and Medical Information

* Student 1 - Does your child have any allergies?

* Student 1 - Please list any allergies and indicate their severity.

* Student 1 - Does your child carry an epi-pen?

Student 1 - Please list any medications your child is currently taking.

Student 1 - Please list any allergies to medicine.

* Student 1 - I certify that my child is up to date on all recommended immunizations. I have spoken with Sigal or Rabbi Bolton regarding special circumstances of my child.

Student 1 - I certify that my child is up to date on all recommended immunizations. I have spoken with Sigal or Rabbi Bolton regarding special circumstances of my child.

If you are willing to share, please let us know if Student 1 is fully vaccinated against Covid-19.

Arrival and Dismissal

Or Zarua offers pick-up from local elementary schools between 72nd and 92nd Streets, east of Park Avenue. See below for registration. If you are interesting in this service but are out of the pickup zone, please contact Sigal Hirsch, shirsch@orzarua.org, before signing up.

Student 1 - I would like my child to come for early arrival. (3 pm-4 pm)

Student 1 - My child will be arriving by:

Student 1 - My child will be leaving:

Student 1 - If you have a caregiver, please indicate the caregiver's name and phone number.

* Student 1 - Please provide us with a list of all people approved to pick up your child, their relationship to your child, and their phone numbers.

If someone not on this list will be picking up your child, you must email Sigal Hirsch (sigalhirsch@orzarua.org) and Deborah Wenger (dwenger@orzarua.org) by 2:30 pm.

After-School Pickup

* Student 1 - Select days for pickup - $300 for one day and $550 for two days. Amount will be prorated for semester options.

Please select the days you’d like to have your child picked up from school.

Sibling Discount: Families are only eligible for sibling discount if children attend the same school. Discount will only to be applied for one child per family and will be applied to the second child registered. The discount will be applied to your account after your registration is completed.

* Student 1 - School Name and Address

* Student 1 - Dismissal Time

Student 1 - Please provide any relevant information about the school or pickup process that the staff member should be aware of.

* Student 1 - I/We hereby give my child permission to be escorted from their elementary school(s) to Congregation Or Zarua and its Or L’Atid program by an Or Zarua staff member, either by walking, bus, or taxi.In consideration of the opportunity for my child(ren) to participate in Or L’Atid’s pick-up service and fully recognizing that such participation involves an element of risk, we hereby knowingly, voluntarily, unconditionally, and without reservation of any kind acknowledge and assume all risks and hazards incidental to such participation and do hereby release, discharge, absolve, indemnify, and agree to hold harmless Congregation Or Zarua and Or L’Atid, and any of their employees, agents, staff, volunteers, members, officers, and trustees, individually and collectively, of, from and against any and all liability, cause of action, claim, demand, cost, expense, and responsibility whatsoever, in law or equity, relating to or arising from my child(ren)’s participation in such pick-up service, including, without limitation, as relating to or arising from any and all damage, injury, illness, medical emergency or death as a direct or indirect result of such pick-up service. I/WE, THE UNDERSIGNED, HAVE READ THIS RELEASE AND UNDERSTAND ALL ITS TERMS AND EXECUTE IT VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.

Student 1 - I/We hereby give my child permission to be escorted from their elementary school(s) to Congregation Or Zarua and its Or L’Atid program by an Or Zarua staff member, either by walking, bus, or taxi.In consideration of the opportunity for my child(ren) to participate in Or L’Atid’s pick-up service and fully recognizing that such participation involves an element of risk, we hereby knowingly, voluntarily, unconditionally, and without reservation of any kind acknowledge and assume all risks and hazards incidental to such participation and do hereby release, discharge, absolve, indemnify, and agree to hold harmless Congregation Or Zarua and Or L’Atid, and any of their employees, agents, staff, volunteers, members, officers, and trustees, individually and collectively, of, from and against any and all liability, cause of action, claim, demand, cost, expense, and responsibility whatsoever, in law or equity, relating to or arising from my child(ren)’s participation in such pick-up service, including, without limitation, as relating to or arising from any and all damage, injury, illness, medical emergency or death as a direct or indirect result of such pick-up service. I/WE, THE UNDERSIGNED, HAVE READ THIS RELEASE AND UNDERSTAND ALL ITS TERMS AND EXECUTE IT VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.

Would like to enroll a second student?

Student 2

* Student 2 - First Name

* Student 2 - Last Name

Student 2 - Nick Name

* Student 2 - Hebrew Name

Student 2 - Birth Date

Student 2 - Email

* Student 2 - School

After School Choice

Student 2 - Please list any information about your child that the teachers should be aware of (i.e. any specific strengths your child might have, preferred learning style, challenges):

Allergies and Medical Information

* Student 2 - Does your child have any allergies?

* Student 2 - Please list any allergies and indicate their severity.

* Student 2 - Does your child carry an epi pen?

If you are willing to share, please let us know if Student 2 is fully vaccinated against Covid-19.

Student 2 - Please list any medications your child is currently taking.

Student 2 - Please list any allergies to medicine.

* Student 2 - I certify that my child is up to date on all recommended immunizations. I have spoken with Sigal or Rabbi Bolton regarding special circumstances of my child.

Student 2 - I certify that my child is up to date on all recommended immunizations. I have spoken with Sigal or Rabbi Bolton regarding special circumstances of my child.

Arrival and Dismissal

Student 2 - I would like my child to come for early arrival. (3 pm-4 pm)

Student 2 - My child will be arriving by:

Student 2 - My child will be leaving:

Student 2 - If you have a caregiver, please indicate the caregiver's name and phone number.

Student 2 - Please provide us with a list of all people approved to pick up your child, their relationship to your child, and their phone numbers.

If someone not on this list will be picking up your child, you must email Sigal Hirsch (sigalhirsch@orzarua.org) and Deborah Wenger (dwenger@orzarua.org) by 2:30 pm.

After-School Pickup

* Student 2 - Select days for pickup - $300 for one day and $550 for two days. Amount will be prorated for semester options.

Please select the days you’d like to have your child picked up from school.

* Student 2 - School Name and Address

Student 2 - Dismissal Time

Student 2 - Please provide any relevant information about the school or pickup process that the staff member should be aware of.

* Student 2 - I/We hereby give my child permission to be escorted from their elementary school(s) to Congregation Or Zarua and its Or L’Atid program by an Or Zarua staff member, either by walking, bus, or taxi.In consideration of the opportunity for my child(ren) to participate in Or L’Atid’s pick-up service and fully recognizing that such participation involves an element of risk, we hereby knowingly, voluntarily, unconditionally, and without reservation of any kind acknowledge and assume all risks and hazards incidental to such participation and do hereby release, discharge, absolve, indemnify, and agree to hold harmless Congregation Or Zarua and Or L’Atid, and any of their employees, agents, staff, volunteers, members, officers, and trustees, individually and collectively, of, from and against any and all liability, cause of action, claim, demand, cost, expense, and responsibility whatsoever, in law or equity, relating to or arising from my child(ren)’s participation in such pick-up service, including, without limitation, as relating to or arising from any and all damage, injury, illness, medical emergency or death as a direct or indirect result of such pick-up service. I/WE, THE UNDERSIGNED, HAVE READ THIS RELEASE AND UNDERSTAND ALL ITS TERMS AND EXECUTE IT VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.

Student 2 - I/We hereby give my child permission to be escorted from their elementary school(s) to Congregation Or Zarua and its Or L’Atid program by an Or Zarua staff member, either by walking, bus, or taxi.In consideration of the opportunity for my child(ren) to participate in Or L’Atid’s pick-up service and fully recognizing that such participation involves an element of risk, we hereby knowingly, voluntarily, unconditionally, and without reservation of any kind acknowledge and assume all risks and hazards incidental to such participation and do hereby release, discharge, absolve, indemnify, and agree to hold harmless Congregation Or Zarua and Or L’Atid, and any of their employees, agents, staff, volunteers, members, officers, and trustees, individually and collectively, of, from and against any and all liability, cause of action, claim, demand, cost, expense, and responsibility whatsoever, in law or equity, relating to or arising from my child(ren)’s participation in such pick-up service, including, without limitation, as relating to or arising from any and all damage, injury, illness, medical emergency or death as a direct or indirect result of such pick-up service. I/WE, THE UNDERSIGNED, HAVE READ THIS RELEASE AND UNDERSTAND ALL ITS TERMS AND EXECUTE IT VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.

Would you like to enroll a third student?

Student 3

* Student 3 - First Name

* Student 3 - Last Name

Student 3 - Nick Name

* Student 3 - Hebrew Name

Student 3 - Birth Date

Student 3 - Email

* Student 3 - School

Educational Background

Student 3 - Please list any information about your child that the teachers should be aware of (i.e. any specific strengths your child might have, preferred learning style, challenges):

Allergies and Medication

* Student 3 - Does your child have any allergies?

* Student 3 - Please list any allergies and indicate their severity.

* Student 3 - Does your child carry an epi pen?

Student 3 - Please list any medications your child is currently taking.

Student 3 - Please list any allergies to medicine.

* Student 3 - I certify that my child is up to date on all recommended immunizations. I have spoken with Sigal or Rabbi Bolton regarding special circumstances of my child.

Student 3 - I certify that my child is up to date on all recommended immunizations. I have spoken with Sigal or Rabbi Bolton regarding special circumstances of my child.

If you are willing to share, please let us know if Student 3 is fully vaccinated against Covid-19.

Arrival and Dismissal

Student 3 - I would like my child to come for early arrival. (3 pm-4 pm)

Student 3 - My child will be arriving by:

Student 3 - My child will be leaving:

Student 3 - If you have a caregiver, please indicate the caregiver's name and phone number.

Student 3 - Please provide us with a list of all people approved to pick up your child, their relationship to your child, and their phone numbers.

If someone not on this list will be picking up your child, you must email Sigal Hirsch (sigalhirsch@orzarua.org) and Deborah Wenger (dwenger@orzarua.org) by 2:30 pm.

After-School Pickup

* Student 3 - Select days for pickup - $300 for one day and $550 for two days. Amount will be prorated for semester options.

Please select the days you’d like to have your child picked up from school.

* Student 3 - School Name and Address

Student 3 - Dismissal Time

Student 3 - Please provide any relevant information about the school or pickup process that the staff member should be aware of.

* Student 3- I/We hereby give my child permission to be escorted from their elementary school(s) to Congregation Or Zarua and its Or L’Atid program by an Or Zarua staff member, either by walking, bus, or taxi.In consideration of the opportunity for my child(ren) to participate in Or L’Atid’s pick-up service and fully recognizing that such participation involves an element of risk, we hereby knowingly, voluntarily, unconditionally, and without reservation of any kind acknowledge and assume all risks and hazards incidental to such participation and do hereby release, discharge, absolve, indemnify, and agree to hold harmless Congregation Or Zarua and Or L’Atid, and any of their employees, agents, staff, volunteers, members, officers, and trustees, individually and collectively, of, from and against any and all liability, cause of action, claim, demand, cost, expense, and responsibility whatsoever, in law or equity, relating to or arising from my child(ren)’s participation in such pick-up service, including, without limitation, as relating to or arising from any and all damage, injury, illness, medical emergency or death as a direct or indirect result of such pick-up service. I/WE, THE UNDERSIGNED, HAVE READ THIS RELEASE AND UNDERSTAND ALL ITS TERMS AND EXECUTE IT VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.

Student 3- I/We hereby give my child permission to be escorted from their elementary school(s) to Congregation Or Zarua and its Or L’Atid program by an Or Zarua staff member, either by walking, bus, or taxi.In consideration of the opportunity for my child(ren) to participate in Or L’Atid’s pick-up service and fully recognizing that such participation involves an element of risk, we hereby knowingly, voluntarily, unconditionally, and without reservation of any kind acknowledge and assume all risks and hazards incidental to such participation and do hereby release, discharge, absolve, indemnify, and agree to hold harmless Congregation Or Zarua and Or L’Atid, and any of their employees, agents, staff, volunteers, members, officers, and trustees, individually and collectively, of, from and against any and all liability, cause of action, claim, demand, cost, expense, and responsibility whatsoever, in law or equity, relating to or arising from my child(ren)’s participation in such pick-up service, including, without limitation, as relating to or arising from any and all damage, injury, illness, medical emergency or death as a direct or indirect result of such pick-up service. I/WE, THE UNDERSIGNED, HAVE READ THIS RELEASE AND UNDERSTAND ALL ITS TERMS AND EXECUTE IT VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE.

Emergency Contact Information

* Medical Insurance Provider

* Policy Number

* Policy Holder

Emergency Contact 1

* Contact 1 - Full Name

* Contact 1 - Relationship

* Contact 1 - Mobile Phone

* Contact 1 - Home Phone

Emergency Contact 2

* Contact 2 - Full Name

* Contact 2 - Relationship

* Contact 2 - Mobile Phone

* Contact 2 - Home Phone

Emergency Contact 3

Contact 3 - Full Name

Contact 3 - Relationship

Contact 3 - Mobile Phone

Contact 3 - Home Phone

Releases and Confirmations

* I release Congregation Or Zarua from all responsibilities other than supervised school activities.

I release Congregation Or Zarua from all responsibilities other than supervised school activities.

* In the event of a medical emergency, if no family member or emergency contact can be reached, I give permission to the faculty of Or Zarua Hebrew School to take any emergency measures which are necessary. I grant permission for my child to be transported by private vehicle or by ambulance to an appropriate medical facility and to be treated by qualified medical authorities at their discretion and that of the program leaders.

In the event of a medical emergency, if no family member or emergency contact can be reached, I give permission to the faculty of Or Zarua Hebrew School to take any emergency measures which are necessary. I grant permission for my child to be transported by private vehicle or by ambulance to an appropriate medical facility and to be treated by qualified medical authorities at their discretion and that of the program leaders.

I grant permission to Congregation Or Zarua to use my child's photograph in its promotional materials and publicity efforts. The photographs may be used in a publication, print ad, direct-mail piece, electronic media (e.g. video, CDROM, Internet), or other form of promotion. I release Congregation Or Zarua, the photographer, employees, agents, and designees from liability for any violation of any personal or proprietary right my child may have in connection with such use.

Registration Fees

* I agree to pay all fees due by the end of the session (REQUIRED)

I agree to pay all fees due by the end of the session (REQUIRED)On the next screen you will have the option to set up a payment plan. An initial payment must be paid with this registration.

Please be sure the plan you set up will ensure that full payment is completed by the end of the session(s) you have registered for.

We request that families agree to pay the 3% convenience fee when paying by credit card.

If you would like to pay by check, please select a plan now, pay an initial deposit, and then contact Helene Santo, (212) 452-2310 x14, or Rachelle Dasher, (516) 399-4613, to have the future payments adjusted.

How did you hear about the Or Zarua After School Program?

Total Tuition Deposit Due Now

Mon, September 16 2024 13 Elul 5784