2022-23 ALEINU Registration 5783 - Form - Congregation Netivot Shalom

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Shalom,

We are thrilled that your child(ren) will join the Aleinu journey this year!

Aleinu: Teen Social Justice at Netivot Shalom is a program for 8th-12th graders providing teens the opportunity to form meaningful social connections as they build their Jewish social justice toolkits. Tzedek, justice, is a core Jewish value, which calls on us to examine inequity and histories of oppression through a systems lens, and take action. Aleinu participants will learn about injustice and the many tools Judaism provides us to both fight it, and to spiritually support our changemaking. They will develop a shared vocabulary of key social justice terms, learn about modes of social change, think critically about their own various identities (Jewish and more), and collectively choose a course of action based on an injustice that is meaningful to them.

If you have any questions, please contact Yael Platt, Aleinu Coordinator, yael@netivotshalom.org

Aleinu Schedule 2022-2023

Aleinu meets on alternating Tuesdays throughout the school year, from 7-9pm at Netivot Shalom. Program dates for 2022-2023 (subject to change):

Fall: September 6 & 20, October 25, November 8 & 29
Winter: December 13, January 3, 17, & 31, February 14 & 28
Spring: March 14 & 28, April 18 & 25, May 9 & 23

* Please select the number of children you are enrolling:

* Child 1 - First Name

* Child 1 - Last Name

Child 1 - Gender Pronouns

she/herhe/himthey/themask me in person

* Child 1 - Date of Birth

Child 1 - Student Phone Number

Child 1 - Student Email Address

Child 1 - Grade in Fall 2022

* Child 1 - Name of School

Please let us know about any of Child 1's learning needs, accessibility needs, health needs, or allergies.

Child 2 - First Name

Child 2 - Last Name

Child 2 - Gender Pronouns

she/herhe/himthey/themask me in person

Child 2 - Date of Birth

Child 2 - Student Phone Number

Child 2 - Student Email

Child 2 - Grade in Fall 2022

Child 2 - Name of School

Please let us know about any of Child 2's learning needs, accessibility needs, health needs, or allergies.

Child 3 - First Name

Child 3 - Last Name

Child 3 - Gender Pronouns

she/herhe/himthey/themask me in person

Child 3 - Date of Birth

Child 3 - Student Phone Number

Child 3 - Student Email Address

Child 3 - Grade in Fall 2022

Child 3 - Name of School

Please let us know about any of Child 3's learning needs, accessibility needs, health needs, or allergies.

Emergency Contact Name and Number

Health Insurance Carrier

CHILD 1

CHILD 2

CHILD 3

Health Insurance Member Number

Name of Primary Doctor

Dr / Health Insurance contact number

Aleinu Enrollment:
$180 = Aleinu Program Enrollment (required full year cost per teen)

Optional Pizza Dinner:
We offer 2 slices of kosher pizza per session for all students who sign up in advance (this is to help us minimize food waste and streamline the process). Teens may opt in or out of pizza dinner. Teens may also bring their own dinner to eat in community with the other participants. We can also accommodate mid-year changes in pizza sign up if necessary.

$90 = Cost for Pizza Dinner (optional full year cost per teen)

Full cost of Aleinu:
Tuition does not cover the full cost of running the Aleinu program. If you are able, please consider making an additional donation.

If you are not a member of Congregation Netivot Shalom, please contact Yael Platt, Aleinu Coordinator to make arrangements.

CHILD 1

CHILD 2

CHILD 3

ENROLLMENT in Aleinu - CHILD 1

Aleinu-enrollment-2022-2023

ENROLLMENT in Aleinu - CHILD 2

Aleinu-enrollment-2022-2023

ENROLLMENT in Aleinu - CHILD 3

Aleinu-enrollment-2022-2023

OPTIONAL PIZZA - CHILD 1

Kosher pizzaNo pizza (no additional fee)

OPTIONAL PIZZA - CHILD 2

Kosher pizzaNo pizza (no additional fee)

OPTIONAL PIZZA - CHILD 3

Kosher pizzaNo pizza (no additional fee)

DONATION

DONATION TO YOUTH & FAMILY EDUCATION

Enrollment charges do not cover the full cost of our education programming. Please consider an additional donation to support Jewish learning for youth at CNS.

Please add an additional donation to the Youth Education Fund by indicating an amount in the box above.

* First Name - Parent/Guardian #1

* Last Name - Parent/Guardian #1

Work Phone - Parent/Guardian #1

Home Phone - Parent/Guardian #1

* Cell Phone - Parent/Guardian #1

* Email - Parent/Guardian #1

* Home Address - Parent/Guardian #1

* City - Parent/Guardian #1

* State - Parent/Guardian #1

* Zip Code - Parent/Guardian #1

First Name - Parent/Guardian #2

Last Name - Parent/Guardian #2

Work Phone - Parent/Guardian #2

Home Phone - Parent/Guardian #2

Cell Phone - Parent/Guardian #2

Email - Parent/Guardian #2

Home Address IF DIFFERENT - Parent/ Guardian #2

City - Parent/ Guardian #2

State - Parent/Guardian #2

Zip - Parent/ Guardian #2

Agreement for participation in Congregation Netivot Shalom's Aleinu program:

Students are enrolled for the time period from September 2022 through May 2023. By completing this registration, I understand that my family is responsible for the entire tuition and that it will be paid in full by February 2023.

Netivot Shalom reserves the right to void this contract at the discretion of the Rabbi in consultation with the Executive Director. In such instances, the unused portion of any prepaid fees may or may not be refunded.

* By checking this box and putting my name in the signature box below, "I agree" that I understand and accept the parameters for participating in the Aleinu program at Netivot Shalom.

By checking this box and putting my name in the signature box below, "I agree" that I understand and accept the parameters for participating in the Aleinu program at Netivot Shalom.

Check this box if you want to discuss with the Aleinu Coordinator any accommodations we can make to the learning environment to help your child.Check this box, if you DO NOT want your child(ren)’s name and/or picture to be included in congregational newsletters, website, and other promotional materials.Check this box if Netivot Shalom Staff DO NOT have permission to dispense over-the-counter medications such as acetaminophen, ibuprofen, or antihistamines to your child(ren).

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