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2017-2018 Emergency Medical Information

Please complete one form for each child or teen you are enrolling. After submitting your first form, please refresh the page and fill out subsequent forms for additional children or teens.

Please note that this form alone does not suffice as Religious/Hebrew School or Teen Programming enrollment.  This form AND the 2017-2018 Religious and Hebrew School Registration Form available here, AND/OR the Teen Programming Registration Form available here, must all be received, as well as a 2017-2018 Bet Haverim Partnership Form (for Religious/Hebrew School registrations, available here), for your child(ren)'s/teens' enrollment to be complete.

All information submitted on this form will be kept strictly confidential.

Questions about this form?  Please connect with Education Director Ardyth Sokoler or Executive Director MK Menard by clicking their names.