CBHCS Student Registration 2025-26 - Form

Please fill out the form below to register your child for CBHCS.

After you fill out this application, please fill out the payment form located here:
CBHCS 2025-26 Payments - Form - Congregation Bet Haverim

For questions regarding CBHCS Registration please contact our Education Director, Jennifer Duretz Peled at education@cbhatlanta.org

For questions regarding payment, please contact the CBH Administrator, Sharon Jackson, at admin@cbhatlanta.org or 404.315.6446

* Parent 1 First Name

* Parent 1 Last Name

* Parent 1 Email

* Parent 1 Mobile Phone

* Parent 1 Address

* City

* State

* Zip

Neighborhood:

* Are you a CBH Member?

Please Select Oneyes I am a memberNo I am not a member

Students may attend the CBH Community School for up to one school year
as a non-member. You must become a member of CBH in order to re-enroll your child. To join, please contact the CBH Office at 404.315.6446.

* Parent 2 First Name

* Parent 2 Last Name

* Parent 2 Email

* Parent 2 Mobile Phone

* Parent 2 Address

* City

* State

* Zip

Neighborhood:

Student #1 Name:

Student #1 Birthday:

Student #1 Pronouns

Name of Weekday School Student #1 Attends:

Student #1: Hebrew Skill Level:

No BackgroundBasicOn LevelAdvanced

Student #1: Previous Religious School Experience Outside of CBH (include name of school and years):

Student #1: List any environmental, food, medicine, or other allergies and any other food restrictions: (i.e. vegetarian)

Student #1: List any medical concerns or medications which may affect your child's classroom experience:

Student #1: List any physical restrictions/limitations your child has that may affect their experience:

Student #1: Does your child have an IEP (Individualized Education Plan)? If so, please describe.

Student #1: Please list two to three goals you have for your child in our program.

Student #2 Name:

Student #2 Birthday:

Student #2 Pronouns:

Name of Weekday School Student #2 Attends:

Student #2: Hebrew Skill Level:

No BackgroundBasicOn LevelAdvanced

Student #2: Previous Religious School Experience Outside of CBH (include name of school and years):

Student #2: List any environmental, food, medicine, or other allergies and any other food restrictions: (i.e. vegetarian)

Student #2: List any medical concerns or medications which may affect your child's classroom experience:

Student #2: List any physical restrictions/limitations your child has that may affect their experience:

Student #2: Does your child have an IEP (Individualized Education Plan)? If so, please describe.

Student #2: Please list two to three goals you have for your child in our program.

Student #3 Name:

Student #3 Birthday:

Student #3 Pronouns:

Name of Weekday School Student #3 Attends:

Student #3: Hebrew Skill Level:

No BackgroundBasicOn LevelAdvanced

Student #3: Previous Religious School Experience Outside of CBH (include name of school and years):

Student #3: List any environmental, food, medicine, or other allergies and any other food restrictions: (i.e. vegetarian)

Student #3: List any medical concerns or medications which may affect your child's classroom experience:

Student #3: List any physical restrictions/limitations your child has that may affect their experience:

Student #3: Does your child have an IEP (Individualized Education Plan)? If so, please describe.

Student #3: Please list two to three goals you have for your child in our program.

Student #4 Name:

Student #4 Birthday:

Student #4 Pronouns:

Name of Weekday School Student #4 Attends:

Student #4: Hebrew Skill Level:

No BackgroundBasicOn LevelAdvanced

Student #4: Previous Religious School Experience Outside of CBH (include name of school and years):

Student #4: List any environmental, food, medicine, or other allergies and any other food restrictions: (i.e. vegetarian)

Student #4: List any medical concerns or medications which may affect your child's classroom experience:

Student #4: List any physical restrictions/limitations your child has that may affect their experience:

Student #4: Does your child have an IEP (Individualized Education Plan)? If so, please describe.

Student #4: Please list two to three goals you have for your child in our program.

* Emergency Contact First & Last Name

Emergency contact is someone other than the parent/guardian.

* Emergency Contact Phone Number

* Emergency contact relationship to child:

Photo Consent

I do give consentI do NOT give consent

Please check preference above regarding permission for your child (listed above) to be photographed during the Community School hours and/or at other synagogue functions, and for these photographs to be used on the CBH website, in brochures, advertisements, or other synagogue related purposes with the sole discretion of the CBH Community School.

Parent Signature

Signature for consent/no consent for photos of child.

Date

PARENT PARTICIPATION

Parent Participation is a vital part of life of the the CBH Community School. Your participation is critical to the strength of our program. Please indicate the areas in which you would be willing to help. We greatly appreciate your involvement and support!

* I can help with CBHCS in these ways:

I am willing to serve as a room parent.

Special Talents

Please let us know of any special talents you may have that could be used as a resource to work with our kids occasionally.

Special Talents:

REMEMBER, YOU MUST GO TO THE PAYMENT PORTION OF REGISTRATION AFTER YOU SUBMIT THIS FORM