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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  • Parent / Guardian Information

  • Father or Guardian 1 Information

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  • Format: (000) 000-0000.
  • Format: (000) 000-0000.
  • Mother or Guardian 2 Information

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

  • Family Information

  • Grandparent Information

  • Grandparents play such an important role in your family's life, and by extension, in our community. They will be invited to attend key School events and witness their grandchildren in action. Please fill out the information below, so that we can get to know them better.

  • In loving memory of our beloved grandparents, who have passed away, we wish to honor their legacy by including the date of their passing.

  • Medical Information

  • 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

  • Consent for Emergency Medical Treatment

    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.

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  • Permission to Administer Medication as Required

    I authorize Elray Jewish Academy and its staff to administer non-prescription medications to my child(ren).
    By entering your name below and submitting, you consent to the terms of this agreement and agree to sign electronically.

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  • 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 staff to administer basic medical care as needed, including, but not limited to, allergy medications, EpiPens, or other minor medical treatments as determined necessary by school personnel. I release and hold the school harmless from any liability arising from the provision of such care.

    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, or, in rare cases, paralysis or death. 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.

    4. Permission for Off-Campus Activities
    I grant permission for my child to leave the school premises under staff supervision for neighborhood walks and school-sanctioned field trips. I acknowledge that any parent volunteering as a driver must hold a valid California driver’s license and meet the minimum legal insurance requirements. All applicable seat belt and safety regulations will be followed.

    5. 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.

    6. Financial Obligation & Enrollment Policy
    I acknowledge that tuition and fees must be paid in accordance with the school's financial policies. I further acknowledge that if an outstanding balance remains before the start of the school year, my child may not be allowed to attend classes until the balance is settled or a formal payment arrangement is approved by the school administration.

    Acknowledgment & Signature
    By signing this page, 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.

    By applying, we understand that if recommended by the school, we may need to get academic and non-academic assistance as needed.

    By submitting this application I give Elray Jewish Academy permission to contact my child(ren)'s present and past school(s) for academic and disciplinary information about my child.

    Please note, the application fee is non-refundable.

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      Application Fee


      $150
        
      Total
      $0.00
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