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21-22 Kesher and Kabbalat Torah Registration

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This is the registration form for PSC's two educational programs: Kesher & Kabbalat Torah. Kesher is PSC's K-7th grade Religious School program. Kabbalat Torah is our post B'Nai Mitzvah program open to grades 8-12. Please note that you will need to submit a separate form for each child.


Getting Ready!

To complete the registration form, you will need:
  • your medical insurance information 
  • If your child will or may take medications while at Kesher programs and events, you will need to complete and submit the downloadable medical release form that can be found below. Note that this form requires a physician's signature.
  • If your child receives specialized services, support, accommodations or interventions at secular school, we'll ask you to upload any documents so that we can most effectively serve your child.
Names
Birthdays and Pronouns
Secular School
Medications
Please tell us about any medications your child will take during youth sessions (including youth group events and retreats if applicable). Even if he/she/they can take the medication independently, you will need to complete and submit the downloadable medical release form. Note that this form requires a physician's signature.
Diet and Allergies
At PSC, all food is kosher dairy in school programs. 
If your child has dietary restrictions, please tell us below.
Please tell us about allergies or other restrictions not listed above.
About Your Child
PSC aims to create a safe, welcoming and productive learning environment for every child. Please share information that will help us do this for your child and family.

Learning and Behavioral Differences
PSC aims to include all individuals. Our youth education programs welcome all children -- whatever their learning style or distinct needs may be -- and we work toward creating meaningful, inclusive learning experiences for all.

If you have any information or concerns about your child's needs in any learning environment of which we should be aware, please indicate below. We will reach out to you for more information.
 About My Child's Learning
Please share any information described above to help us help your child, including diagnosis, condition, educational or social concern, learning difference, challenge with behavior, or any other distinctions of which we should be aware."
Please share any information described above to help us help your child.
Enrollment Information
Please choose your child's grade level and any options specific to that grade.
Mazal Tov! (Congratulations!)
Fifth grade is when Kesher begins preparing families to celebrate bar or bat mitzvah. Some children begin earlier and some children start later (and celebrate later).

Please let us know your plans or interests.
We'd love to celebrate this milestone with you at PSC as well.
We would welcome the chance to talk with you and hear your thoughts about bar or bat mitzvah decisions.
Teen Options
Youth Groups
PSC's youth groups are a critical part of our youth department!

PSC's youth groups are affiliated with USY (United Synagogue Youth), the Youth Movement of Conservative Judaism. We have three youth groups here at PSC:
  • Our 8th-12th graders are invited to be involved in Senior USY, also known as FRUSY. FRUSY holds multiple chapter events per month. Our teens are eligible to attend multiple regional weekends per year through New Frontier Regional USY, as well as USY's annual International Convention in December 2021.                                                                                                         
  • Our 3rd-7th graders are invited to be involved in Kadima. PSC's Kadima chapter holds one event per month on Sunday afternoons, and are eligible to attend regional Kadima programming throughout the year through New Frontier Regional USY.                                                                                                                                                                                                                               
  • Our Kindergartners-2nd graders are invited to be involved in Machar. PSC's Machar chapter holds one event per month on Sunday afternoons.
adult information
Tell us about the adults associated with your child(ren).
First Adult
We rely upon volunteer effort to make our programs run. We welcome your assistance!
Please share any suggestions you have about other ways you can help.
Second Adult
We rely upon volunteer effort to make our programs run. We welcome your assistance!
Please share any suggestions you have about other ways you can help.

If we are unable to reach you or another adult listed above, provide information of other adults we can contact in case of an emergency.
Child Insurance Information


Please read the information in the sections below carefully and mark your acceptance as necessary.

Emergency Protocols/Permission to Seek Treatment
If and when a child requires medical attention, PSC personnel will make every effort to reach a parent or guardian. If we are unable to reach a parent or guardian, the following instruction will remain in force unless revoked by the parent or guardian:
  • In the event of an emergency where the parent cannot be reached, I hereby authorize Peninsula Sinai Congregation or its authorized representative to call my child’s physician (or another physician) for necessary care for my child. I agree to pay all expenses incurred. This authorizations shall remain effective from August 22, 2021 – June 5, 2022.
  • In the event of an emergency where the parent cannot be reached, I further authorize Peninsula Sinai Congregation or its authorized representative to consent to any x-ray examination, anesthetic, medical or surgical diagnoses or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any licensed physician or surgeon, whether at the said physician’s office or licensed hospital. 
  • I give this authorization in advance of any specific examination, diagnosis, treatment or hospital care being required, and in order to provide authority and power on any and all such examinations, diagnoses, treatments or hospital care which the aforementioned physician in the exercise of his/her best judgment may deem advisable.
Emergency Release/Assumption of Risk
  • Parents and guardians, jointly and separately, release Peninsula Sinai Congregation, its officers, agents, and employees from all liability for injuries, illness or property damage resulting from my family/child’s participation in any PSC sponsored activities and agree not to make any claim or demand against them for any or all losses or damages to student/family’s person or property.
  • By participating in PSC’s youth programs you understand, acknowledge, and agree, on behalf of yourself and persons for whom you are legally responsible, that attendance at PSC’s youth programs involves the potential for exposure to COVID-19.  By participating and attending, you willingly assume such health risk and assume full responsibility.  In consideration of participation and attendance at PSC’s youth programs, you hereby release, waive, and agree not to sue PSC with respect to any claim of a Covid-19 infection arising from participation in PSC’s youth programs.
Photography Release

We often use photographs of students and families on our website or in other publicity. We do not include names or other identifying information when we use these pictures. 

  • I/we give unconditional permission to Peninsula Sinai Congregation to photograph me and/or my child(ren) and to use the photographs to publicize PSC and its programs in publications, advertisements, websites or news articles pertaining to PSC, without payment or other compensation of any kind.  
Park Permission Slip

On occasion, Kesher, Kabbalat Torah, Kadima, and/or USY may go across the street to Boothbay Park for educational and/or recreational activities. This is general permission for your child to participate in those activities throughout the school year.
  • I/we give consent for my child to participate in PSC Youth activities at Boothbay Park. I understand that PSC does not assume responsibility or liability in case an accident occurs. I/we release PSC, its officers, directors, trustees, faculty, agents, and employees, together with parents and other volunteers, from any and all costs, demands, damages, liability, claims, causes of action, and responsibility of any nature in connection with these activities.


Deadline to Register 
To assist us in preparing for the coming school year, we ask that you register your child prior to August 15.

Tuition
Your flexible commitment to PSC includes the operating costs of our youth programs. As such, your flexible commitment form for the 2021-2022 Fiscal Year needs to be submitted in order for your child to participate in Kesher and/or Kabbalat Torah programs.
The form is located here: https://peninsulasinai.shulcloud.com/form/21-22-flex-form.html

If you have any questions, please call or email the office: 650-349-2816 or info@peninsulasinai.org
Mon, October 25 2021 19 Cheshvan 5782