Rabbi Eric Morgenstern - Kehillah Chen v'Chesedkcvc.org/wp-content/uploads/2017/07/Enrichment-Cohort-Forms.pdf · JPS Hebrew-English TANAKH, Student Edition Price: $30.56 Available

5850 Canoga Avenue, Suite 110, Woodland Hills, CA 91367 Ph: 818-245-KCVC (5282) Fx: 818-587-2969

Email: [email protected]

Dear supporters of our Chevra Kadisha, I am grateful that you are continue to share and support our community. We welcome and encourage participation in our many spiritual, social and enrichment programs offered throughout the year including High Holy Days, Special Holiday Programs and Mitzvah Days. Also, please don’t forget to join us for Shabbat services which are held at 7:00PM on the Third Friday of each month at the First Presbyterian Church of Encino. Shabbat Services could not be complete without an Oneg Shabbat that is typically hosted by some of our families. Since you will be participating in our Enrichment Sessions, there are several forms attached that will assist us. Please complete them and return to us as soon as possible.

• KCVC Supporter Information (IF REQUIRED) • Medical Treatment • Enrichment Enrollment • Disaster / Emergency Form • Release Form • High Holy Day Reservation Form • Pledge Form

If you have any questions or need further assistance, I can be reached at (818) 245-(KCVC) 5282 or by email at [email protected]. I look forward to hearing from you. Very truly yours,

Rabbi Eric Morgenstern Rabbi Eric Morgenstern

Member of the International Federation of Rabbis Enclosure


www.kcvc.org

Tell Us About Your Family…

Family Name: _____________________________________________________ Adult One: _________________ Adult Two: ________________ Hebrew Name: _________________ Hebrew Name: ________________ Birth Date: _________________ Birth Date: ________________ Child One: _________________ Child Two: ________________ Hebrew Name: _________________ Hebrew Name: ________________ Birth Date: _________________ Birth Date: ________________ Child Three: _________________ Child Four: ________________ Hebrew Name: _________________ Hebrew Name: ________________ Birth Date: _________________ Birth Date: ________________ Primary Phone: _________________ Cell Phone: ________________ Primary Email: _________________ Facebook: ________________ Home Address Street ________________________________________________________________ City ______________________________________ Zip _______________________


www.kcvc.org

Emergency Contact Name ______________________________________Phone ____________________ Kehillah Chen v’Chesed maintains its relationship data for official synagogue use only. Supporters may choose to be included in the social directory which is distributed to supporters only. I grant Kehillah Chen v’Chesed, its representatives and employees the right to take photographs and videos of me (and my family and guests), and authorize KEHILLAH CHEN V’CHESED, its assigns and transferees to copyright, use the photographs and videos in its promotional and marketing material and publicity efforts. I hereby hold harmless and release KEHILLAH CHEN V’CHESED, its representatives and employees from liability for any violation of any personal or proprietary right it may have in connection with such use. I agree that KEHILLAH CHEN V’CHESED may use such photographs and videos of me with or without my name and for any lawful purpose, including print and/or electronic usage. ______________________________ ________________________________ 1st Adult Signature 2nd Adult Signature Date: _________________________ Date: __________________________


www.kcvc.org

Kehillah Chen v’Chesed embraces the tradition of remembering and honoring those who influenced and enriched our lives, but who have passed from this life. Please provide the information requested below so that we may include your loved one(s) on our Yahrzeit List and you will be sent a reminder 2 weeks before the date (use a separate sheet if necessary) Name Relationship Date of Death __________________________ _______________ ___/___/______ Name Relationship Date of Death __________________________ _______________ ___/___/______ Name Relationship Date of Death __________________________ _______________ ___/___/______ Name Relationship Date of Death __________________________ _______________ ___/___/______ Name Relationship Date of Death __________________________ _______________ ___/___/______ Name Relationship Date of Death __________________________ _______________ ___/___/______ Name Relationship Date of Death __________________________ _______________ ___/___/______ Name Relationship Date of Death __________________________ _______________ ___/___/______



Release Kehillah Chen v’Chesed maintains its relationship data for official synagogue use only. Supporters may choose to be included in the social directory which is distributed to supporters only. I grant Kehillah Chen v’Chesed, its representatives and employees the right to take photographs and videos of me (and my family and guests), and authorize Kehillah Chen v’Chesed, its assigns and transferees to copyright, use the photographs and videos in its promotional and marketing material and publicity efforts. I hereby hold harmless and release Kehillah Chen v’Chesed, its representatives and employees from liability for any violation of any personal or proprietary right it may have in connection with such use. I agree that Kehillah Chen v’Chesed may use such photographs and videos of me with or without my name and for any lawful purpose, including print and/or electronic usage. _____________________________________ Community Supporter Signature _____________________________________ Community Supporter Signature Date ________________________________



Emergency / Disaster Release Form Student: First Name __________________Last Name_______________________ Home Address _______________________________________________ Home Phone_______________ Mother’s Name: ______________________________________________ Work Phone_______________ Cell Phone_______________ Father’s Name: ______________________________________________ Work Phone_______________ Cell Phone_______________ Guardian (if different than above) Name: _____________________________________________________ Work Phone_______________ Cell Phone_______________ Release Statements: Circle One: I authorize release of my son/daughter to any adult with Whom he/she feels comfortable. Yes No I wish for my son/daughter to remain at school until picked up by parent. Yes No



If I/we are unable to pick up our child, I/we designate the following People to whom my son/daughter may be released in case of emergency: Name: ______________________________________________________ Work Phone_______________ Cell Phone_______________ Name: ______________________________________________________ Work Phone_______________ Cell Phone_______________ Please list a friend or family member, who lives out of state that we can call with information in case local Telephone service is interrupted. Name: ______________________________________________________ Relationship:_________________________________________________ Work Phone_______________ Cell Phone_______________ Medical Alert: Condition: ________________________________________ ____________________________________________________________ Medication___________________________________________________ Form Completed by: Name (Print) _________________________________________________ Signature____________________________________________________ Relationship to Student: _______________ Date: __________________



High Holy Day Services Reservation Form Name: ______________________________________________________ Address: ______________________________________________________ ______________________________________________________ Phone: ______________________________________________________ ================================================================== Please tell us which services you will be attending and how many seats you will need. c Erev Rosh Hashanah (September 20th at 7:00 pm) ________ c Rosh Hashanah (September 21st at 10:00 am) ________ c Kol Nidre (September 29th at 7:00 pm) ________ c Yom Kippur (September 30th at 10:30 am) ________ c Yom Kippur Study Session (September 30th at 4:00 PM) ________ c Yizkor / Ne’ila / Havdalah (September 30th at 5:30 pm) ________ ***Please Note: Although High Holiday Service Attendance is "free of charge” we would truly appreciate any financial support you could offer. Please leave what you can in the Tzadakah Box or in the envelopes provided. L’shanah Tova!!



Sunday Enrichment Sessions

9:00 AM – 10:30 AM (Grades 6-7)

Child 1___________________________________________________ Child 2___________________________________________________

11:00 AM – 1:00 PM (Grades 4-5)

Child 1___________________________________________________ Child 2___________________________________________________

1:30 PM – 3:00 PM (Post Bar / Bat Mitzvah)

Child 1___________________________________________________ Child 2___________________________________________________

**All Enrichment Sessions will take place at the Synagogue 4963 Balboa Blvd, Encino, CA 91316

THIS SCHEDULE SUBJECT TO CHANGE BASED UPON ENROLLMENT

RecommendedBookList–Grades4-5

MISHKANT'FILAH:JOURNALEDITION,NON-TRANSLITERATEDPrice:$16.00Availableat:CCARPressOnlinewww.ccarnet.org

DerechBinah:TheHebrewPrimerPrice:$13.95Availableat:BehrmanHouse www.behrmanhouse.com

TheBookofJewishHolidaysPrice:$14.95Availableat:BehrmanHouse www.behrmanhouse.com

WelcomeToIsraelPrice:$13.95Availableat:BehrmanHouse www.behrmanhouse.com

RecommendedBookList–Grades6-7

**ForthosepreparingfortheirB’naiMitzvah,youwillneedtopurchasetheParashabookrelatingtoyourB’naiMitzvahDate.Rabbiwilladviseastowhichportionyouneed.Hereisthewebsiteforthebooks:ParashaHaShavuahAvailableat:BehrmanHouse Price:$13.50http://www.behrmanhouse.com

ForKids-PuttingGodonYourGuestList-2ndEdition:HowtoClaimtheSpiritualMeaningofYourBarorBatMitzvahPrice:$16.99Availableat:AmazonOnlinewww.amazon.com

MakingaDifference:PuttingJewishSpiritualityintoAction,OneMitzvahataTimePrice:$11.95Availableat:BehrmanHouse www.behrmanhouse.com

JPSHebrew-EnglishTANAKH,StudentEditionPrice:$30.56Availableat:AmazonOnlinewww.amazon.com

A Jewish Universalist Synagogue


www.kcvc.org

DATE TIME EVENT / HOLIDAY • August 18, 2017 7:00 PM Family Shabbat Service • August 20, 2017 Enrichment Session Begin • September 3, 2017 LABOR DAY HOLIDAY • September 15, 2017 7:00 PM Family Shabbat Service • October 6, 2017 5 -7 PM Community Sukkot / Dinner • October 28, 2017 8:30 – Noon Pay It Forward Day • November 19, 2017 7:00PM Interfaith Thanksgiving • November 19 & 26, 2017 THANKSGIVING HOLIDAY • December 15, 2017 7:00PM Family Hanukkah Celebration • December 17, 2017 – January 7, 2018 WINTER VACATION • January 14, 2018 MARTIN LUTHER KING WEEKEND • January 19, 2018 7:00PM Family Shabbat Service • January 21, 2018 Enrichment Sessions Resume • January TBD Community Tu B’Shevat • February 16, 2018 7:00PM Family Shabbat Service • February 18, 2018 PRESIDENTS DAY WEEKEND • March 16, 2018 7:00PM Family Shabbat Service

A Jewish Universalist Synagogue


www.kcvc.org

• March 25 & April 1, 2018 SPRING VACATION • March 31, 2018 5:00 PM Community Passover Seder • April 8, 2018 Enrichment Sessions Resume • April 11, 2018 7:00 PM Yom HaShoah • April 20, 2018 7:00PM Family Shabbat Service • May 13, 2018 MOTHERS DAY WEEKEND • May 18, 2018 7:00PM Family Shabbat Service • May 20, 2018 Last Day of Enrichment Sessions • May 20, 2018 Shavuot



Enrichment Program Suggested Supply List Dear Parents, I am very excited about beginning a new year and could really use your help with classroom supplies. Please make every effort to purchase the supplies on this list and have your child bring them to every class session. Thank you.

1 box of crayons 2 erasers 2 glue sticks 3 different colored highlighters 1 pack of water-based markers 1 pencil box 5 pencils (no. 2) 5 pens (blue or black) 1 Large loose leaf notebook with 4 Pocket folders 1 package of loose leaf notebook paper 1 package of plastic sheet protectors (10) 1 inch/cm ruler 1 pair of scissors 1 roll of scotch tape



Medical Treatment Authorization Form This form grants temporary authority to a designated adult to provide and arrange for medical care for a minor in the event of an emergency, where the minor is not accompanied by either parents or legal Guardians, and it may not be feasible or practical to contact them. This form should be given to the trip leader or shown to the trip leader and then carried by the designated adult. Minor Full Legal Name: ___________________________________________________________________ Home Address: ____________________________________________________________________ ____________________________________________________________________ Date of Birth: ______________________ Gender: F____ M____ Information for Medical Treatment Physician’s Name and Location of Practice: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ Physician’s Phone # (if known): (____) ________________ Medical Insurer/Health Plan: ________________ Policy #: ___________________ Allergies to Medications: ________________________________________________ Allergies (Other): ________________________________________________________



Please note all conditions for which the child is currently receiving treatment and any other significant medical information: ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ ______________________________________________________________________ AUTHORIZATION AND CONSENT OF PARENT(S) OR LEGAL GUARDIAN(S) I do hereby state that I have legal custody of the aforementioned Minor. I grant my authorization and consent for _________________________________________ (hereafter “Designated Adult”) to administer general first aid treatment for any minor injuries or illnesses experienced by the Minor. If the injury or illness is life threatening or in need of emergency treatment, I authorize the Designated Adult to summon any and all professional emergency personnel to attend, transport, and treat the minor and to issue consent for any X-ray, anesthetic, blood transfusion, medication, or other medical diagnosis, treatment, or hospital care deemed advisable by, and to be rendered under the general supervision of, any licensed physician, surgeon, dentist, hospital, or other medical professional or institution duly licensed to practice in the state in which such treatment is to occur. I agree to assume financial responsibility for all expenses of such care. It is understood that this authorization is given in advance of any such medical treatment, but is given to provide authority and power on the part of the Designated Adult in the exercise of his or her best judgment upon the advice of any such medical or emergency personnel. This authorization is effective through: ______________________________________. Signed this _______________day of________________________, 20_____________. Parent / Legal Guardian Signature: _________________________________________ Printed Name: __________________________________________________________ Witness Signature: ______________________________________________________ Printed Name: __________________________________________________________



Family Pledge Family Name: _____________________________________________________

Suggest Annual Pledge of Support $500.00 (Your pledge supports monthly Shabbat and High Holy Day services; Music; Use of the First Presbyterian Church of Encino; Liability Insurance and Board of Directors Insurance)

Enrichment Program (Grades 3-5) $720.00 Enrichment Program (Grade 6-7) $540.00 Post Bar / Bat Mitzvah (Grade 8-12) $360.00 Enrichment Classroom Fee $75.00 (Your pledge supports the use of the First Presbyterian Church of Encino)

B’nai Mitzvah Ceremony

Community Supporter $1800.00 Non-Community Supporter $2200.00

(This includes the services of the Rabbi, ONE of our Cantorial Soloists; B’nai Mitzvah Equipment Transportation & Set Up Fee $200.00

Oneg Shabbat $36.00 (Your pledge supports monthly Oneg Shabbat)

Prayer Book Pledge ($42 per book): $_________ (Your pledge allows for the purchase of Shabbat, Weekdays and Festival Prayer Books to be kept at the Synagogue, identified with a book plate)

Grand Total Pledge of Support: $_________ The best way to submit your pledge is through KCVC's PayPal online system and then forward this form to us for accurate processing. It's safe and easy. Pledges may be sent to KCVC by postal mail. All pledges submitted by postal mail, including third party payments, must be sent to KCVC with a copy of this Pledge Schedule. Checks and money orders must be made payable to Kehillah Chen v’Chesed (NO Acronym’s Please) in U.S. funds only and sent to the Synagogue address.

Documents

Rabbi Eric Morgenstern - Kehillah Chen v'Chesedkcvc.org/wp-content/uploads/2017/07/Enrichment-Cohort-Forms.pdf · JPS Hebrew-English TANAKH, Student Edition Price: $30.56 Available