Kesher and Nesiah Registration Form

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Welcome to Kesher and Nesiah!

Visit our website for full program descriptions. Please note that we are updating our database and therefore are not including a “child information same as last year” option. Thank you for your patience as we update our records!

Use promo code EARLYBIRD21 if you are registering before June 30 for a $50 early-bird discount. Use promo code SIBLING21 for $50 off if you are registering more than one student. Use code EARLYSIBLING21 for $100 off you are registering more than one student before June 30.

Parent/Guardian Information

Add a Parent

* First Name

* Last Name

* Email

* Mobile Phone

Work Phone

* Street Address

Apt/Unit/Bldg/Ste

* City

* State

* Zip

* In the event a parent/guardian cannot be reached for an emergency, please contact:

* Relation

* Mobile Phone

Child Information

Add a Child

* First Name

Middle Name

* Last Name

* Date of Birth

* School Grade

* School Attending

Date of Bar/Bat Mitzvah (if applicable)

* In which program(s) are you enrolling this child? (Kesher, Kesher Community Days, or Nesiah)

If your child has any allergies, please list them and describe the severity of the reaction in the field below.

If your child has physical limitations and/or pre-existing medical conditions (including mental health) please describe below.

Does your child have an IEP or 504? If so, what learning accommodations are made for this child?

Is there more information you feel is important for us to know? If so, please let us know in the field below.

Insurance Information

* Insurance Company Name

* Insurance ID Number

* Name(s) of Insured

Upload Photo(s)

Please upload a recent photo of your child(ren)

I will email a current photo of each child to Sharon Graetz (sgraetz@aasynagogue.org)

Volunteering

* Please help us strengthen our program(s) by selecting (at least) one volunteer opportunity during the year

Be on the Education Committee (attend quarterly meetings and help guide current and future programming)Be a room parent (send an occasional email to your child’s class and help collect money for year-end teacher gifts)Volunteer at a holiday program (High Holidays, Sukkot, Chanukah, Purim, and/or Passover)Host a Kesher event at your home (opportunities may include Shabbat dinner or Havdallah)

Payment

* Please choose the quantity of children being enrolled for each program (Kesher, Kesher Community Days, or Nesiah)

Kesher (3 Years - PreK) - $750

Kesher (K - 1st Grade) - $950

Kesher (2nd - 6th Grade) - $1350

Kesher Community Days Only - $550

Nesiah (7th - 9th Grade) - $1400Fees for Kesher and Nesiah include High Holiday Children’s Programming, Sukkot Family Lunch, Sparks of light (Chanukah) and Purim PaloozAA. Families who register for one of these programs will also receive $100 off Shabbaton 2022.

Total

* Confirmation Email

We will send you a confirmation of your submission.

* Electronic Signature

I acknowledge that all the medical information I provided is complete, including medications, allergies, disorders, pre-existing conditions, etc.

* Electronic Signature

I hereby grant permission for my child(ren) to fully participate in all activities of the Ahavath Achim Synagogue. I understand that field trips will be adequately supervised. Transportation will be arranged by parent carpools, employees of the Ahavath Achim Synagogue, school buses, or walking. I will be informed beforehand of all such trips. I agree to indemnify and hold the synagogue and the employees harmless from any claim, cause of action, and/or liability that might result from my child traveling with an employee of the synagogue.

* Electronic Signature

As the parent/guardian of the child(ren) named above, I hereby give permission for the child to receive first aid, emergency medical transportation and emergency medical treatment (including x-ray examination, anesthetic, medical or surgical diagnosis) while in the care of Ahavath Achim Synagogue/HomeBeis@AA and its’ employees. I understand that I will be responsible for all costs incurred as a result of an emergency medical situation while my child is in the care of Ahavath Achim Synagogue/HomeBeis@AA.

* Electronic Signature

As the parent/guardian of the child(ren) named above, I grant permission for my child(ren) to participate in youth education programs at Ahavath Achim as part of HomeBeis@AA. My signature hereby releases and forever discharges Ahavath Achim Synagogue and its officers, trustees, employees, advisors, coordinators, chaperones, agents and their respective heirs at law, legal representatives, successors and assigns from any and all claims, demands, damages, actions, causes of action, suits and liabilities of every kind and nature, arising out of, resulting from, or relating to any incidents that may occur during these programs, including but not limited to any bodily injury to such child.

* Electronic Signature

I hereby grant permission to Ahavath Achim Synagogue and its representatives to photograph and/or video record my child(ren) and any adults in our family at events sponsored by Ahavath Achim Synagogue/HomeBeis@AA and to publish said photos or videos in any Synagogue publication, including social media and/or local Atlanta publications.

Friday, April 19 2024 11 Nisan 5784