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2023-2024 After School Registration
Please verify reCaptcha before submitting the form.
Join us at Or Zarua this fall!
Contact Sigal Cohen, scohen@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
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
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?
Please Select One
Yes
No
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?
Please Select One
Yes
No
*
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
Please Select One
Single
Married
Separated
Divorced
Widowed
Other
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 - Full Session
Please Select One
Full Year ($1550)
Winter ($1,300)
None
Student 1 - Half Session
Please Select One
Full Year ($775)
Fall ($300)
Winter ($650)
None
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?
Please Select One
Yes
No
*
Student 1 - Please list any allergies and indicate their severity.
*
Student 1 - Does your child carry an epi-pen?
Please Select One
Yes
No
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.
Please Select One
Yes
No
Prefer not to say
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 - My child will be arriving by:
Please Select One
Or Zarua After School Pick Up
Accompanied by parent or caregiver
Car driver or car service
Bus or subway
Student 1 - My child will be leaving:
Please Select One
Accompanied by a parent or caregiver
By car pool driver or car service
By bus or subway
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 student pickup option
Please Select One
Full Year - $200
Fall Semester - $80
Winter Semester - $120
None
*
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?
Please Select One
Yes
No
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 - Full Session
Please Select One
Full Year ($1170)
Fall ($450)
Winter ($975)
None
Student 2 - Half Session
Please Select One
Full Year ($590)
Fall ($225)
Winter ($485)
None
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?
Please Select One
Yes
No
*
Student 2 - Please list any allergies and indicate their severity.
*
Student 2 - Does your child carry an epi pen?
Please Select One
Yes
No
If you are willing to share, please let us know if Student 2 is fully vaccinated against Covid-19.
Please Select One
Yes
No
Prefer not to say
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
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 2 - My child will be arriving by:
Please Select One
Or Zarua After School Pick Up
Accompanied by parent or caregiver
Car driver or car service
Bus or subway
Student 2 - My child will be leaving:
Please Select One
Accompanied by a parent or caregiver
By car pool driver or car service
By bus or subway
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
Please Select One
Full Year - $200
Fall Semester - $80
Winter Semester - $120
None
*
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?
Please Select One
Yes
No
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 - Friday Full Session
Please Select One
Full Year ($1090)
Fall ($420)
Winter ($910)
None
Student 3 - Friday Half Session
Please Select One
Full Year ($545)
Fall ($210)
Winter ($455)
None
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?
Please Select One
Yes
No
*
Student 3 - Please list any allergies and indicate their severity.
*
Student 3 - Does your child carry an epi pen?
Please Select One
Yes
No
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.
Please Select One
Yes
No
Prefer not to say
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 3 - My child will be arriving by:
Please Select One
Or Zarua After School Pick Up
Accompanied by parent or caregiver
Car driver or car service
Bus or subway
Student 3 - My child will be leaving:
Please Select One
Accompanied by a parent or caregiver
By car pool driver or car service
By bus or subway
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
Please Select One
Full Year - $200
Fall Semester - $80
Winter Semester - $120
None
*
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, social media), 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.
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, social media), 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
Thu, May 9 2024 1 Iyyar 5784
