TGS & BJE Jewish Enrichment Program Enrolment - Form

Dear parents,

Use this form to enroll your child in The Great Synagogue's Jewish Enrichment Program at Bellevue Hill Public School or Rose Bay Public School for the 2019 School Year.* The Jewish Enrichment Program is a continuation of the Board of Jewish Education's Year 4 Extension, tailored especially for Years 5 & 6 as they grow towards their Bar and Bat Mitzvahs.

Classes are held during BJE term dates:
- at Bellevue Hill Public School on Mondays and Fridays from 8:15-9:00am
- at Rose Bay Public School on Mondays from 3:20-4:50pm.

The cost for the Jewish Enrichment Program at either school for the 2019 school year is $705.

We run a number of exciting excursions and Shabbatons at The Great Synagogue throughout the year. Stay tuned for the full calendar, coming soon!

*If you would like to enroll your child in the Jewish Enrichment Program at Reddam House instead, please click here.

Details of Student

* Student's Surname

* Student's First Name(s)

* Gender

* Date of Birth

Born:

Before SunsetAfter SunsetThis is used to calculate the student's Hebrew birthday.

* Year in School

* School Student Attends

Please Select OneBellevue Hill Public SchoolRose Bay Public SchoolOther

Other School

* JEP Class Student Will Attend

Please Select OneBellevue Hill Public SchoolRose Bay Public School

Student Medical Details

Does the student have:

AsthmaADHDAllergiesNone

If allergies, please specify:

* Does the student take/need medication?

Please Select OneNoYes

Please specify:

Any other issues that we should be aware of:

Details of Parent or Guardian 1

* Title

* Parent's First Name

* Parent's Surname

* Relationship to Student

Please Select OneMotherFatherOther

Please specify:

* Mobile Phone

Work Phone

* Email

*Confirmation email will go to this address*

* Unit/Street no.:

* Street name:

* Suburb/Town:

* Postcode

Details of Parent or Guardian 2

Title

Parent's First Name

Parent's Surname

Relationship to Student

Please Select OneMotherFatherOther

Please specify:

Mobile Phone

Work Phone

Residential Address

Please Select OneSame as Parent/Guardian 1Different Address

Unit/Street no.:

Street name:

Suburb/Town:

Postcode

Media Consent

I/We, the person(s) whose signature appears below, hereby give my/our consent for submitted photos or videos of my child/ren and/or myself to be used by The Great Synagogue and/or any of its officers, employees, contractors or agents (collectively TGS) and the New South Wales Board of Jewish Education and/or any of its officers, employees, contractors or agents (collectively BJE) in the course of or in connection with the operations and activities of TGS and BJE.

I/We confirm that I am/ we are authorised to give this permission. I/we give my/our consent for the submitted photograph(s) or video footage to be displayed in newspapers and magazines (whether print or digital), on any TGS and BJE website, on any social media platform and in any promotional material or brochures that TGS and BJE may use or develop. I/we also release and hold harmless TGS and BJE, their contractors, employees and any third party involved in the creation or publication of such material from liability for any claims by me/us or any third party in connection with the use of this/these photograph(s) or video(s).

I/we understand that:
· All material gathered is subject to the editorial discretion of TGS and BJE; and
· TGS and BJE may at its sole discretion and without being required to consult with me /us, elect to use or not use, all or any of the material gathered.

Type Name to Confirm Media Consent

Date

Re-Type Name to Confirm Media Consent

The Great Synagogue reserves the right to request your written signature at a later date.

Payment

* Please tick the box to accept the charge

Full 2019 Year - $705If you are unable to make full payment at this time, please contact The Great Synagogue office on admin@greatsynagogue.org.au or 9267 2477 to discuss other payment options.