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Fierverker Jewish Learning Community (FJLC) Registration


Directions:
Please review and COMPLETE A FORM FOR EACH CHILD. The below information will be shared with your child's teacher to help enrich your child's Religious School experience.

Please advise the Fierverker Jewish Learning Community (FJLC) Principal of any changes during the school year. 


Student Information





Parent/Guardian Information





List student's sibling (s).

Student Background
Please type in all information in the text boxes provided below.



Health and other information
Please type in all information in the text boxes provided below.






Insurance Information
Please type in all information in the text boxes provided below.


Emergency Contact Information
If I/we cannot be reached in case of a serious injury or illness please contact the person listed below (this is an emergency contact and should NOT be a parent).


Permissions and Authorizations
Please type in all information in the text boxes provided below.


Thank you. We appreciate you taking the time to fill out your child's registration. You will receive a confirmation email once the form is complete.

Sun, December 4 2022 10 Kislev 5783