J-FLEx 2020-21 Registration - Form - Congregation Gates of Prayer

The official start of J-FLEx will begin with J-FLEx@Home on Sunday, October 11, 2020. J-FLEx@Gates of Prayer will begin the following Sunday, October 18, 2020 from 9:30 - 10:30 AM. Our starting date for our Thursday night 8th/9th Grade program, led by Rabbi Erdheim, will be October 22, 2020 at 6:30 PM. For those 8th/9th Graders unable to attend on Thursday evening, there will be a virtual option beginning Sunday, October 18, 2020 at 9:30 AM.

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Because of the uncertain nature of our J-FLEx year, we will not be charging our typical tuition of $399.00 Instead, we would ask that you make a donation to our Educational programming if you are able.

J-FLEx Student (J-FLExer) Name (#1)

J-FLExer (#1) Birth Date

J-FLExer (#1) Current Secular School Grade 2020-2021

J-FLExer (#1) Level

Level expected to participate in J-FLEx

J-FLExer # 1 will most likely participate.....

J-FLEx@HomeJ-FLEx @Gates of Prayer ( outside when feasible with social distancing and mask wearing)J-FLEx @Home & Gates of PrayerJ-FLEx @Gates of Prayer 8th/9th Graders Only (In-person Thursdays 6:30 PM )J-FLEx@Home 8th/9th Graders ( Sundays 9:30 AM )

J-FLEx Student (J-FLExer) Name (#2)

J-FLExer (#2) Birth Date

J-FLExer (#2) Current Secular School Grade 2020-2021

J-FLEx (#2) Level

Level expected to participate in J-FLEx

J-FLExer # 2 will most likely participate.....

N/AJ-FLEx@HomeJ-FLEx @Gates of Prayer ( outside when feasible with social distancing and mask wearing)J-FLEx @Home & Gates of PrayerJ-FLEx@Home 8th/9th Graders - Sunday 9:30 AMJ-FLEx@Gates of Prayer 8th/9th Grade Thursday at 6:30 PM

Parent's Name (A)

Parent's E-mail Address (A)

Parent's Mobile Number (A)

Parent's Name (B)

Parent's E-mail Address (B)

Parent's Mobile Number (B)

Primary Address

Home Phone Number

Does your child spend time in two homes?

No. Our child spends all his/her time at the primary address.Yes. Our child will spend time at two homes throughout the year.

Secondary Address

I would like to receive text messages regarding J-FLEx events and closings.

Yes - Parent (A)No - Parent (A)Yes - Parent (B)No - Parent (B)No more than one text message per week on average

Member of Congregation Gates of Prayer

YesNo- I/we are in the process of joining Congregation Gates of Prayer.

In addition to Parents A & B, I would like the following to receive all the information regarding the J-FLExers registered on this application.

Please include name, E-mail address, mobile number and relationship to J-FLExers.

Other J-FLExer (#1) Interests:

Other J-FLExer (#2) Interests:

Does your child (#1) have any documented learning challenges? If so, please explain:

How can we better serve your child (#1) with his/her/zir learning challenges? Please share any tactics or advice you or other adults have used in the past.

Does your child (#2) have any documented learning challenges? If so, please explain:

How can we better serve your child (#2) with his/her/zir learning challenges? Please share any tactics or advice you or other adults have used in the past.

Does your child (#1) have any medical issues for which we need to be aware, including a positive Covid-19 diagnoses? How can we better serve your child with his/her/zir medical needs?

Does your child (#2) have any medical issues for which we need to be aware, including a positive Covid-19 diagnoses? How can we better serve your child with his/her/zir medical needs?

Non Parent Emergency Contact Information

(Please include name, phone number and relationship to child) Please inform this contact that they are listed as your child's non-parent emergency contact.

J-FLEx Parent (A) Partnership Opportunities

Drive for Field TripsPhotographerSet Up & Monitor Kehillah Kafe (7th-Conf.)Substitute Arts/CraftsTechnologyCookingJ-FLEx Specialist (Various Sundays)Yoga InstructorI would be interested in helping out in the following ways. For more details contact Phil Gaethe at 885-2600 or via E-mail at educator@gatesofprayer.org

I would like to lead a J-FLEx Experience on......

Please describe any expertise (cooking, music, art, technology, etc.) you may have that could be utilized in a J-FLEx Sunday morning or weeknight Experience.

J-FLEx Parent (B) Partnership Opportunities

Drive for Field TripsPhotographerJ-FLEx Specialist (Various Sundays)Set Up & Monitor Kehillah Kafe (7th-Conf.)Substitute Yoga InstructorI would be interested in helping out in the following ways. For more details contact Phil Gaethe at 885-2600 or via E-mail at educator@gatesofprayer.org

I would like to lead a J-FLEx Experience on......

Please describe any expertise (cooking, music, art, technology, etc.) you may have that could be utilized in a J-FLEx Sunday morning or weeknight Experience.

Agreement for Limited COVID-19 Release

1. I am aware that there are risks associated with my child contracting COVID-19 by participating in J-FLEx programming during the COVID-19 pandemic. There are risks associated with entering the facility, being on synagogue grounds and/or being in contact with CGoP/J-FLEx employees during the COVID-19 pandemic.

2. On behalf of myself and/or my child, I knowingly assume all possible COVID-19 exposure risks, both known and unknown, relating to my child's presence in or outside the facility or receiving services from CGoP/J-FLEx.

3. I hereby release, waive, relinquish, and discharge the CGoP/J-FLEx, along with its owners, officers, directors, managers, employees, from any and all claims, demands, liabilities, rights, damages, expenses, and causes of action in any way related to the COVID-19 pandemic.

4. My child will not participate in J-FLEx@Gates of Prayer if he/she/zie has been exposed to Covid-19 within 14 days of any J-FLEx program. This does not exclude my child from participating in J-FLEx@Home.

5. My child will not participate in J-FLEx@Gates of Prayer if he/she/zie is feeling unwell, including, but not limited to, vomiting, fever, coughing, soar throat. body aches, etc. This does not exclude my child from participating in J-FLEx@Home.

By checking this box I accept the Covid-19 statements listed on this registration form.

Because of the uncertain nature of our J-FLEx year, we will not be charging our typical tuition of $399.00 Instead, we would ask that you make a donation to our Educational programming if you are able.