Congregation Beth Ahm Religious School

Student Information Form

2009 - 2010

Student Name:  ____________________________________________      Phone:  _____________________

Address:  _______________________________________________________________________________    

Please indicate any medical conditions, including food allergies, the Religious School staff should be aware of:  ________________________________________________________________________________________

________________________________________________________________________________________

Mother:  __________________________________________________      Phone:  _____________________  (if different from student's)

Address:  _________________________________________________       E-mail:  _____________________

(if different from student's)

Father:  ___________________________________________________      Phone:  _____________________

                                                                                                                          (if different from student's)

Address:  _________________________________________________       E-mail:  _____________________

(if different from student's)

Guardian:  _________________________________________________     Phone:  _____________________

                                                                                                                          (if different from student's)

Address:  __________________________________________________     E-mail:  _____________________

(if different from student's)

Please indicate the telephone number to call for unexpected school closings:

For Wednesday Classes:  ____________________         For Sunday Classes:  _______________________

(Every effort will be made to contact you for closings due to adverse weather conditions, however, please note that if Windsor Public Schools are closed due to weather, the Religious School will also be closed.)

Please indicate the person(s) to be contacted during school hours in case of an emergency:

For Wednesday Classes:                                                   For Sunday Classes:

Name:  _________________  Phone:  __________           Name:  _________________  Phone:  __________

Relationship to Student:  ____________________         Relationship to Student:  ____________________

Name:  _________________  Phone:  __________           Name:  _________________  Phone:  __________

Relationship to Student:  ____________________         Relationship to Student:  ____________________

Name of Doctor:  _________________________________________________    Phone:  ________________

I give permission to take my child to ___________________________ Hospital in case of an emergency.

Signature of Parent or Guardian:  ________________________________________  Date:  ____________

**You can now check www.congregationbethahm for school closings and other information**