Online Registration

Student Information

Please fill out the form to register your child(ren) for the 2017 - 2018 School Year.  Each form can be used to register three children from the same family.  Any questions about registration can be directed to the Religious School office at cwatts@basrs.org or 904-268-4200, ext. 145.


Student 1 Name:
(1) Hebrew Name:
(1) Grade Enrolling:
(1) Date of Birth:
 /  / 
(1) Gender:
(1) School Attending:


Student 2 Name:
(2) Hebrew Name:
(2) Grade Enrolling:
(2) Date of Birth:
 /  / 
(2) Gender:
(2) School Attending:


Student 3 Name:
(3) Hebrew Name:
(3) Grade Enrolling:
(3) Date of Birth:
 /  / 
(3) Gender:
(3) School Attending:

Family Information

Family Address:
Primary Family Phone Number:
-
Primary Family E-mail:

Parent / Guardian Information

(1) Parent/Guardian Name:
(1) Parent/Guardian Phone:
-
(1) Parent/Guardian E-mail:
(1) Parent/Guardian Religious Affiliation:
(1) Parent/Guardian - Are you a JJC Member?:


(2) Parent/Guardian Name:
(2) Parent/Guardian Phone:
-
(2) Parent/Guardian E-mail:
(2) Parent/Guardian Religious Affiliation:
(2) Parent/Guardian - Are you a JJC Member?:

Emergency Contacts

(1) Name:
(1) Relationship:
(1) Phone:
-
(2) Name:
(2) Relationship:
(2) Phone:
-
Do you authorize the above emergency contacts to advise the school regarding the welfare of your child in the event that you the parent(s)/guardian(s) can not be reached?

Medical Information

Doctor(s) Name:
Doctor's Phone:
-
List any known allergies:

Policies and Permissions

I give permission to the Bernard & Alice Selevan Religious School at the Jacksonville Jewish Center to use photographs or videos of my child and or myself in any publication or advertisement, whether they be in print, video or online.

I give permission to the Bernard & Alice Selevan Religious School at the Jacksonville Jewish Center to include the following information in our school directory "Friend Finder", so that students and their familes can keep in touch with each other outside of school:

Recognizing the fundamental role technology plays in the 21st Century, the Bernard & Alice Selevan Religious School supports and encourages the appropriate and responsible use of technology in student learning. The Bernard & Alice Selevan Religious School will take reasonable measures to protect students and ensure that technology use aligns with educational objectives. The current policy, including rules and regulations, is found at http://parentportal.basrs.org/acceptable-use-policy/ or may be obtained at the school office. It is the responsibility of the student and parent/guardian to understand the current policy. By selecting and option below, I acknowledge I have read and reviewed with my student the rules and regulations associated with the Bernard & Alice Selevan Religious School Acceptable Use policy. Furthermore, I acknowledge these rules and regulations apply to both Galinsky Academy and personal devices while on school property.


I undertsand that my child(ren) is expected to maintain a minimum of 80% attendance of all scheduled classes while enrolled in grades 2 - 7.

By clicking the submit button below I am acknowledging that I have filled out the information on this registration form to the best of my abilities and will update the Bernard & Alice Selevan Religious School Office of any changes.  I acknowledge that I will be receiving addition paperwork (Financial Contract, Personal Information Form and Discipline Policy) that must be completed and turned in for my child(ren)'s enrollment to be complete.

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