OVS Building Blocks 2024-2025

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Building Blocks Dates
March 2, 2025
March 9, 2025
March 16, 2025
March 23, 2025
March 30, 2025
April 6, 2025
April 27, 2025
May 4, 2025 – Last Day of Class

Classes will be held from 10:00 am - Noon.

FAMILY INFORMATION

* Parent/Guardian (1) Name

Parent/Guardian (2) Name

* Parent/Guardian (1) Best Phone Number

Parent/Guardian (2) Best Phone Number

* Parent/Guardian (1) Email

Parent/Guardian (2) Email

Parent/Guardian (1) Street

Parent/Guardian (2) Street (If Different)

Parent/Guardian (1) City

Parent/Guardian (2) City (If Different)

Parent/Guardian (1) State

Parent/Guardian (2) State (If Different)

Parent/Guardian (1) Zip

Parent/Guardian (2) Zip (If Different)

Emergency Contact Name

Emergency Contact Cell Phone

STUDENT INFORMATION

Student (1) First Name

Student (2) First Name

Student (3) First Name

Student (1) Last Name

Student (2) Last Name

Student (3) Last Name

Student (1) Hebrew Name

Student (2) Hebrew Name

Student (3) Hebrew Name

Student (1) Birthday

Student (2) Birthday

Student (3) Birthday

School Grade (as of 9/1/24) - Student (1)

School Grade (as of 9/1/24) - Student (2)

School Grade (as of 9/1/24) - Student (3)

Is there anything you'd like to share about student (1)?

Is there anything you'd like to share about student (2)?

Is there anything you'd like to share about student (3)?

ALLERGY INFORMATION

Does Student (1) have any allergies?

Yes. My child has allergies.No. My child has no allergies.

Does Student (2) have any allergies?

Yes. My child has allergies.No. My child has no allergies.

Does Student (3) have any allergies?

Yes. My child has allergies.No. My child has no allergies.

List all allergies student (1):

List all allergies student (2):

List all allergies student (3):

FAMILY MEDICAL INFORMATION

* Electronic Signature for Medical Release. Please enter your full name in the box below.

Doctor's Name:

Doctor's Phone Number:

Health Insurance Company

Policy ID Number

Group Number

Medical Release

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

I certify that my child(ren) is (are) in good physical health. They have my permission to participate in all activities that are part of the regular religious school program.

PUBLICITY RELEASE

From time to time your child(ren)’s photo may be taken in our classrooms or special events. We use these photos in synagogue eblasts, on printed materials or in other advertisements for OVS.

Yes, I give my permission for my child(ren)'s photo to be used.No, I do not give permission for my child(ren)'s photo to be used.

By clicking yes, you are agreeing that you child(ren)'s photograph may be used in synagogue eblasts, on printed materials or in other advertising for OVS or Building Blocks.

* Number of Children

End of Year Special - $100 for March - May 2024.

Total Due

Please click submit to advance to the payment page.

If you require financial assistance, please contact Adam Kofinas, Executive Director, at 404-633-1737.

Sat, March 29 2025 29 Adar 5785

Congregation Or VeShalom

404-633-1737 | office@orveshalom.org
1681 N Druid Hills Road | Brookhaven, GA 30319

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