Shireinu Application Form 2025 - Form - Torah Ohr Hebrew Academy

* Family Name

Home Phone

If applicable.

* Street Address

* City

* State

* Zip Code

* Father's Name

* Father's Cell

* Father's Email Address

* Mother's Name

* Mother's Cell

* Mother's Email Address

This will be used as primary email for all communications.

* MOM: Do you read your emails regularly?

Please Select OneYesNo

* MOM: Do you receive automated text messaging?

Please Select OneYesNoDuring the summer season, Shireinu sends out important info, arrival updates, and more via automated text broadcasts.

* Marital Status

* Synagogue Affiliation

* Family Reference Name

* Family Reference Relation

* Family Reference Phone

* Family Rabbi

* Emergency Contact Name

* Emergency Contact Relation

* Emergency Contact Phone

* Family Doctor

Name and Phone

* What access do your children have to Computer/ Internet/ Devices and what is the means of securing full safety?

* Child #1 Name

* Child #1 DOB

* Child #1 Age

* Child #1 School

* Child #1 Grade in Sept. 2025

* Child #1 All Previous Schools

* Child #1 Session Attending

* Child #1 Technology

Please Select OneDoesn't have a phoneHas a filtered flip phoneHas a non-filtered flip phoneHas a smartphonePlease select what applies. Please Note: Absolutely no cell phones, iPods, or any other electronic devices are allowed to be brought.

* Child #2 Name

* Child #2 DOB

* Child #2 Age

* Child #2 School

* Child #2 Grade in Sept. 2025

* Child #2 All Previous Schools

* Child #2 Session Attending

* Child #2 Technology

* Child #3 Name

* Child #3 DOB

* Child #3 Age

* Child #3 School

* Child #3 Grade in Sept. 2025

* Child #3 All Previous Schools

* Child #3 Session Attending

* Child #3 Technology

* Child #4 Name

* Child #4 DOB

* Child #4 Age

* Child #4 School

* Child #4 Grade in Sept. 2025

* Child #4 All Previous Schools

* Child #4 Session Attending

* Child #4 Technology

Additional Information

Allergies, Special Conditions, Concerns, Etc.

* Are you interested in Instructional Swim Lessons?

Please Select OneYesNoShould we form a group, a separate application form will be sent out following acceptance.

How did you hear about Shireinu?

For First-Time Applicants

DRESS CODE AND GUIDELINES:

At Shireinu, girls are expected to dress appropriately, in accordance with the Torah laws of modesty.

* Knees must be covered at all times.

Knees must be covered at all times.

* Elbows must be covered at all times.

Elbows must be covered at all times.

* Knee-highs OR Tights must be worn at all times.

Knee-highs OR Tights must be worn at all times.

* Clothing (Tops and Skirts) cannot be clingy & tight fitting.

Clothing (Tops and Skirts) cannot be clingy & tight fitting.

* Ankle Socks are NOT allowed to be worn.

Ankle Socks are NOT allowed to be worn.

* Leggings are NOT allowed to be worn.

Leggings are NOT allowed to be worn.

These and any other Tzniut rules enforced by the establishment must be abided by. Cooperation is necessary. Note that these rules and any other policies enforced are strictly for the benefit of our girls, and to bring honor to the Name of Hashem.
GIRLS WHO CONTINUOUSLY REFUSE TO ABIDE BY THESE RULES WILL BE SUBJECT TO DISMISSAL.

* I agree to abide by the dress code, guidelines, and all other regulations enforced by Shireinu.

I agree to abide by the dress code, guidelines, and all other regulations enforced by Shireinu.

CONTRACT AND TERMS OF AGREEMENT:

1. Absolutely no iPods, mp3s, cell phones, smartwatches, or any other electronic devices are permitted to be brought to Shireinu, besides for a non-internet-capable camera. If seen, they will be confiscated and the child will be suspended.

2. THIS APPLICATION MUST BE ACCOMPANIED BY FULL PAYMENT in order for the application to be processed. Checks may be post-dated thru August 2025.

3. We offer early bird prices to make the job of the office easier. Early Bird prices are ONLY valid if we receive the application and full payment by FEBRUARY 27, 2025.

4. You will receive an Admission Pass once all forms and payments are submitted. Children will NOT be permitted on the first day without an Admission Pass.

5. REFUNDS: THERE IS NO REDUCTION OR REFUND OF FEES DUE TO ABSENCE, ILLNESS OR WITHDRAWAL, including unforeseen circumstances, (e.g. canceling, suspension, etc.). No replacements (giving your slot to someone else) will be allowed for cancelations.

6. The Medical Form (click to download) must be submitted by Tuesday, May 13, 2025. Exam must be after August 22, 2024.

7. The Early Bird Special and Full Summer Rate are not available to first half attendees who decide to remain for the second half (or vice versa).

8. Parents will be held responsible for any and all medical bills incurred, ח”ו, during the summer.

9. Torah Ohr / Shireinu Summer Program will not be held responsible for any personal items that are either lost, stolen, or left behind throughout the summer.

10. Parents will be held responsible for any and all damages incurred to property.

11. Torah Ohr / Shireinu Summer Program reserves the right to remove or suspend a child from the program at their discretion. Payments may or may not be refunded.

12. Shireinu T-shirt: Girls must wear the Shireinu T-shirt for all trips. T-shirts are $20. RXL Division has their own shirt and it is $20 as well. More info will be sent out following acceptance.

13. Overnights: Cuties and Bloomers Divisions do not go on overnight trips.

14. Late Start: Program for a division(s) may start late on days when the trip the previous day returned after 10:00 PM. Parents will be informed if there will be a late start.

15. Early Dismissal & Off-Days: Please note, there will be a 12:15 PM dismissal on the following days: Lunch will not be served. • Friday, July 4th
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* I would like to enroll my daughter(s) in Shireinu Summer Program 2025 and we agree to abide by all of Shireinu’s rules and regulations, including, but not limited to, those listed above.

I would like to enroll my daughter(s) in Shireinu Summer Program 2025 and we agree to abide by all of Shireinu’s rules and regulations, including, but not limited to, those listed above.

TRIP AUTHORIZATION & HOLD HARMLESS AGREEMENT

My daughter(s) has/have permission to attend Shireinu Summer Program, a division of Torah Ohr Hebrew Academy, and take part in all activities, trips, etc.

This agreement releases Torah Ohr Hebrew Academy and all its staff or volunteers from all responsibilities and liabilities relating to injuries that may occur, G-D forbid, during the summer program, both on or off the Torah Ohr campus, regardless of whether the injuries are caused by negligence or not.
By signing below, I forfeit all rights to bring a lawsuit against Torah Ohr Hebrew Academy or any of its staff or volunteers for any reason.
Pictures and videos taken at our exciting events may be posted on Torah Ohr's website, posters within the shul, in flyers, emails, etc. By signing below, I am giving consent for my daughter(s) to be included in photographs and videos taken at any event.
In addition, I give my daughters(s) permission to receive emergency medical treatment.
This agreement additionally releases Torah Ohr Hebrew Academy and the owners of the pools Shireinu will be using from all liability relating to injuries that may occur during the use of their pools. By signing this agreement, I agree to hold Torah Ohr Hebrew Academy and the owners of the pools entirely free from any liability, including financial responsibility for injuries incurred, regardless of whether injuries are caused by negligence or not. In addition, I acknowledge the risks involved in swimming. These include, but are not limited to, drowning, losing consciousness, injuring oneself, G-d Forbid. I declare that my daughter is participating voluntarily, and that all risks have been made clear to me. Additionally, my daughter(s) does not have any conditions that will increase her likelihood of experiencing injuries while engaging in this activity.
By signing below, I forfeit all rights to bring a suit against Torah Ohr Hebrew Academy or the owners of the pools for any reason. In return, my daughter(s) will receive access to their pools along with Shireinu Summer Program. My daughter(s) will also make every effort to obey safety precautions. I will ask for clarification when needed.

* I allow my daughter(s) to walk/bike to and from Shireinu on her own.

Please Select OneYesNo

* I give Torah Ohr Hebrew Academy/Shireinu the authority to sign trip waiver forms for my daughter(s).

Please Select OneYesNo

* I, the undersigned, fully understand and agree to the above terms.

I, the undersigned, fully understand and agree to the above terms.

* Parent/Guardian Name

* Parent/Guardian Signature

* Date

* Payment Type

Select a Payment TypeCashCheckZelle to Shireinu@TorahOhr.comCredit CardPayment must be made in FULL in order for the application to be processed.

-Checks may be post-dated through August 2025.
-Credit Card payment plan may be set until August 31, 2025.

* Total # of Children you are Applying For

In Cuties Division (1-3 Grade) ONE HALF ONLY

In Cuties Division (1-3 Grade) FULL SUMMER

In Bloomers & Tweens Divisions (4-7 Grade) ONE HALF ONLY

In Bloomers & Tweens Divisions (4-7 Grade) FULL SUMMER

In Rina XL Division (8 Grade) ONE HALF ONLY

In Rina XL Division (8 Grade) FULL SUMMER

Please indicate how many children you are applying for, which session, and in which divisions.

Total Due

Pricing for Cuties Division
(Entering 1-3 Grade)
	First Half	Second Half	Full Summer
Early Bird (exp. Feb. 27)	$1,425	$1,425	$2,800
Regular Price	$1,475	$1,475	$2,900
After March 24	$1,555	$1,555	$3,060
After May 26	$1,665	$1,665	$3,280

Pricing for Bloomers & Tweens Divisions
(Entering 4-7 Grade)
	First Half	Second Half	Full Summer
Early Bird (exp. Feb 27)	$1,495	$1,495	$2,915
Regular Price	$1,545	$1,545	$3,015
After March 24	$1,625	$1,625	$3,175
After May 26	$1,735	$1,735	$3,395

Pricing for Rina XL Division
(Entering 8 Grade)
	First Half	Second Half	Full Summer
Early Bird (exp. Feb. 27)	$1,595	$1,595	$3,115
Regular Price	$1,645	$1,645	$3,215
After March 24	$1,725	$1,725	$3,375
After May 26	$1,800	$1,800	$3,525

* I understand that my application will not be processed until Cash payment is received.

I understand that my application will not be processed until Cash payment is received.Payment can be dropped off at the Torah Ohr Office (hours below).

* I understand that my application will not be processed until Check payment is received.

I understand that my application will not be processed until Check payment is received.Checks may be split and post-dated through August 2025. Payment can be mailed or dropped off at the Torah Ohr Office (hours below).

* Check Payments

Please upload a picture of your Check / Checks in order to submit application.

* Zelle Payment Confirmation

ZELLE TO SHIREINU@TORAHOHR.COM
Please upload a screenshot of your Zelle payment confirmation in order to submit application.

Sponsor a Child at Shireinu! Enter Donation Amount

All proceeds go towards The Camp Fund, allowing children from our community the opportunity to thrive and flourish in a summer program and grow in ways they are not able to during the year.
Donations are tax-deductible.

CLICK HERE TO DOWNLOAD MEDICAL FORM.
Due Tuesday, May 13, 2025

Upload Medical Form

Exam date must be after August 22, 2024.

Forms and payments may be mailed or dropped off at the Torah Ohr Office,
581-D Middle Neck Road, Great Neck, NY 11023. Office Hours: 2:00-5:00 PM, Mon-Thurs
QUESTIONS? shireinu@torahohr.com or (516) 441-7776