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2021-2022 Setzer Youth Education Registration

Section A: Family Contact Information

If there is a secondary contact, all emails and mailings will go to both contacts. In case of urgent need, the primary contact will be notified first.

Please indicate yes, no, or any other permissions in this field.
Section B: Student Enrollment Information
We ask that every family commits to some financial contribution, however we are very happy to discuss alternate financial arrangements with any family who needs it.
Student 1 Information
As a guide, incoming High School Seniors will be 2022 and incoming Kindergartners will be 2034.
Information will not be shared publicly. Parents/Guardians will be copied on all email communication to students.
Information will not be shared publicly. 
Please describe allergies and/or medications with dosage and timing.
Feel free to share any special interests, talents, struggles, aversions, or pieces of personal history that are relevant and will enable us to fully support your child.
Student 2 Information
As a guide, incoming High School Seniors will be 2022 and incoming Kindergartners will be 2034.
Information will not be shared publicly. Parents/Guardians will be copied on all email communication to students.
Information will not be shared publicly. 
Please describe allergies and/or medications with dosage and timing.
Feel free to share any special interests, talents, struggles, aversions, or pieces of personal history that are relevant and will enable us to fully support your child.
Student 3 Information
As a guide, incoming High School Seniors will be 2022 and incoming Kindergartners will be 2034.
Information will not be shared publicly. Parents/Guardians will be copied on all email communication to students.
Information will not be shared publicly.
Please describe allergies and/or medications with dosage and timing.
Feel free to share any special interests, talents, struggles, aversions, or pieces of personal history that are relevant and will enable us to fully support your child.
Student 4 Information
As a guide, incoming High School Seniors will be 2022 and incoming Kindergartners will be 2034.
Information will not be shared publicly. Parents/Guardians will be copied on all email communication to students.
Information will not be shared publicly.
Please describe allergies and/or medications with dosage and timing.
Feel free to share any special interests, talents, struggles, aversions, or pieces of personal history that are relevant and will enable us to fully support your child.
Section C: Release Forms
Medical Release

By signing my name below, I grant permission for my child(ren) to participate in all activities that are part of the regular program of Setzer Youth Education at the Jacksonville Jewish Center in Jacksonville, FL. I hereby authorize Michelle Penson, Rabbi Rosenblum, or any person designated by them, to obtain emergency medical care for my child(ren) in the event such care is necessary. I give permission for my child(ren) to receive emergency medical care by any nurse, doctor, paramedic, or licensed member of a medical staff in a hospital or clinic. I understand that every effort will be made to notify a parent/guardian prior to treatment.

By typing my name, I confirm I have read, understand, and agree to the above.
Transportation Release
I acknowledge that field trips may be arranged by the Jacksonville Jewish Center and transportation may include a chartered van/bus or another vehicle driven by a parent/guardian from our Center community.
 
By typing my name, I confirm I have read, understand, and agree to the above.
Media Release
Your child(ren)'s photo will be taken during youth group or at special events. We use these photos on the synagogue website, bulletin boards, in congregational/youth emails, in private Facebook groups, and other publicity materials including, but not limited to, CenterPieces and the Jewish Federation and Foundation of Northeast Florida's Jewish Life Magazine.
Section D: Family Engagement
We strive to build powerful Jewish experiences for our youth with the support of volunteers for ongoing projects as well as specific programs and events. Beyond the logistical assistance, it is meaningful for our students to see adults modeling Jewish communal engagement.  

Below, you will have an opportunity to share some of the ways in which you would like to be involved as a volunteer.

Section F: Donation Information

Setzer Youth Education will never turn away a child due to financial need. While we do charge dues, much of our operational funds are provided through the generosity of our community. Please consider making an additional contribution below. All donated funds will go towards programming for our Youth Groups and/or engagement opportunities for our Post B'nei Mitzvah Programming. All donations, of any amount, are greatly appreciated! 
Sun, January 23 2022 21 Shevat 5782