Confirmation Class 2026

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Student Information (complete one per child)

* Student First Name

* Student Last Name

Student Hebrew Name

* Birth Date

Secular School

Current Grade

Did the Student attend IPRS?

YesNo

If no, where did the student attend and for how long?

Medical Information & General Learning Profile

Please list any allergies or medical conditions that may impact your student during class hours:

Please list if there any any medications your student takes:

Food Allergies/Intolerances (with Medical implications) and reaction:

Limitations or concerns that may affect participation?

YesNo

If yes, please explain

Permission to call an ambulance in case of emergency?

YesNo

General Learning Profile

Confidentiality will be respected

Does your student take medication during the school day to support learning?

YesNo

Does your student receive academic services (IEP, GT, ARD, etc.)?

YesNo

If yes, the Head of School will contact you to discuss how we can support your child in the religious school environment. Paperwork is not required.

Additional information you'd like to know (e.g., strengths, dislikes, home changes, etc.):

Family Information

Address:

May we include your student in Agudas Achim social media and communications?

YesNo

Parent/Guardian #1 Name

Parent/Guardian #1 Occupation

Parent/Guardian #1 Email

Parent/Guardian #1 Phone Number

Parent/Guardian #2 Name

Parent/Guardian #2 Occupation

Parent/Guardian #2 Email

Parent/Guardian #2 Phone Number

Emergency Contacts

Emergency Contact #1 Name

Emergency Contact #1 Phone Number

Emergency Contact #2 Name

Emergency Contact #2 Phone Number

Are these emergency contacts authorized to pick up your child?

YesNo

* Ready to Enroll?

Ready to Enroll?

Total Amount

Tue, January 13 2026
24 Tevet 5786

Update this content.

Tue, January 13 2026 24 Tevet 5786

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