School Application Form for Elray Jewish Academy

  • Application Form

  • What you'll need:

    1. Photo of your child 2. Most recent report card 3. Immunization Form

  • Student Information

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  • Does your child have friends at Elray?
  • Has your child ever been educationally evaluated?*
  • Has your child had emotional, social, or behavioral issues requiring professional help?*
  • Is your child receiving support services or accommodations?*
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  • Parent / Guardian Information

  • Father or Guardian 1 Information

  • Jewish by birth or conversion?*
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  • Format: (000) 000-0000.

  • Mother or Guardian 2 Information

  • Jewish by birth or conversion?*
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  • Format: (000) 000-0000.
  • Does the child have another parent/guardian at a different address?*
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  • Sibling Information

  • Family Information

  • Medical Information

  • Epipen required?*
  • Inhaler required?*
  • Is the child immunized according to California SB277 law?*

  • Please note: Elray Jewish Academy does not accept students not immunized according to California State Law SB 277.

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  • Insurance Information

  • Format: (000) 000-0000.

  • Emergency Contacts

  • In case you are unable to reach me during an emergency, you are authorized to contact and, if necessary, release my child to any of the following:

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • Agreements & Consents

  • Parental Consent

    1. Immunization Compliance
    I understand that my child(ren) must be up to date on all vaccinations required by the Department of Health to be enrolled at Elray Jewish Academy. It is my responsibility to ensure that my child(ren) remains in compliance with the immunization schedule. I acknowledge that if I fail to meet this requirement, my child(ren) may be excluded from attending school until all required vaccines are administered.

    2. Medical Consent & Authorization
    I authorize Elray Jewish Academy and its staff, Hatzolah, or trained EMT's to render care and obtain all emergency medical or dental care prescribed for my child(ren). This care may be given under whatever conditions are necessary to preserve the life, limb or wellbeing of my child(ren); and I assume any financial responsibility arising from said treatment. I authorize Elray Jewish Academy and its staff to administer non-prescription medications to my child(ren).

    Furthermore, if in the opinion of a properly licensed and practicing physician my child requires urgent medical or surgical intervention and I am unavailable to provide consent, I authorize the school to act on my behalf to furnish such consent. I agree to reimburse the school for any medical expenses incurred on behalf of my child.

    3. Acknowledgment of Risk in School Activities
    I acknowledge that participation in school activities and the use of school equipment involve inherent risks, including—but not limited to—minor injuries such as cuts and bruises and more serious risks such as fractures, head or spinal injuries. I understand that this is not an exhaustive list of all potential risks. By signing below, I grant permission for my child to participate in all school activities and assume full responsibility for any associated risks.

    I agree to indemnify and hold the Academy, its Board of Trustees, and its employees, agents, representatives and assigns harmless from any and all claims, expenses, and costs for personal injuries or damage sustained by my child while attending the Academy or while participating in school activities such as athletics, field trips, and other Academy-sponsored events, unless the injuries or damages are the result of the willful misconduct of the Academy.

    4. Media Release & Use of Student Image
    I consent to my child’s name, photograph, voice, image, and other identifying information being used by the school in promotional materials, social media, publications, and the school website, without compensation or prior notice. I also permit my child to be interviewed by media representatives during school-related activities. I release and hold the school harmless from any liability arising from such usage.

    5. Standards for Student and Parent Behavior
    I acknowledge that a positive and constructive relationship between the Academy and the student, as well as between the Academy and the parent, is essential for the fulfillment of the Academy’s educational purpose. Therefore, I agree to abide by the terms of the Academy’s Policies and Standards as well as the Parent/Student Handbook. I further understand that the Head of School or his designee, in his, in his or her sole discretion, retains the right for any cause he deems sufficient, to suspend or expel a student. I acknowledge that a positive and constructive relationship between the Academy and the student, as well as between the Academy and the parent, is essential for the fulfillment of the Academy’s educational purpose. Therefore, I agree to abide by the terms of the Academy’s Policies and Standards as well as the current version of the Parent/Student Family Handbook, and all subsequent updates, revisions and amendments done by the Academy in its sole discretion. I further understand that the Head of School or his designee, in his, in his or her sole discretion, retains the right for any cause he deems sufficient, to suspend or expel a student.

    6. Participation in School Activities/Field
    I agree and give permission for my child to participate in any and all Academy activities including athletics and Academy-sponsored field trips away from campus, unless the Academy receives written notification to the contrary.

    7. Emergency Medical Care and Services
    I agree to indemnify and hold the Academy, its Board of Trustees, its employees, agents, representatives and assigned harmless from any and all claims, damages, expenses, and costs of medical care and services provided to the student arising out of any illness or inquiry sustained by the student while attending the Academy.

    8. Legal disputes
    In the event that you engage in a legal dispute with the Academy regarding your children/family, you are responsible to reimburse the Academy for any and all costs and indemnify the Academy.

    9. Disruption of School Operations
    I understand that a “Force Majeure Event” may necessitate a cessation of or change in all or part of the Academy Academy’s operations. A “Force Majeure Event” includes, but is not limited to, any fire, flood, act of God (earthquake, tsunami, volcanic eruption, hurricane, tornado, lightning, etc.), governmental action, or acts or threats of the following: terrorism, epidemic, pandemic, viral outbreak, war, revolution, natural disaster, riot, strike, lockdown, or any event beyond the Academy’s reasonable control, or that makes performance inadvisable, impracticable, illegal or impossible in the Academy’s determination.

    10. Force Majeure
    If a Force Majeure Event occurs, I understand that the Academy shall be entitled, in its sole discretion, to immediately and without notice: (1) extend, condense, or otherwise modify the school year; (2) change the facilities in which the Academy’s educational program, including classes, programs, activities and events, (“Program”) are held; (3) change the manner and format of the Program, including but not limited to changing to an on-line electronic format, independent or parent-guided study, or any other format or manner; or (4) postpone or cease all or part of its operations and its duties, obligations, and performance under this Contract. I further understand that their obligations under this Contract remain and will continue, and that no portion of any tuition, fees or other payments made by me or that are outstanding will be forgiven or refunded if the Academy’s operations cease or are postponed, suspended or modified because of any Force Majeure Event.

    Acknowledgment & Signature
    By signing this page electronically, I confirm that I have read and understood all terms outlined in this agreement. I voluntarily agree to arbitration and waiver of important constitutional rights to trial by judge or by jury, as well as the right to appeal. I voluntarily agree to abide by these conditions as a prerequisite to my child’s enrollment at Elray Jewish Academy. The undersigned is advised of the right to have independent counsel review this agreement prior to signing this agreement.

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