2021-22 Teen Hub Enrollment

Thank you for joining us for the 2021-22 School Year! If you are enrolling multiple teens in Teen Hub, please fill out one form per child. Please make sure you are logged in before you begin the form. Your name will be shown in the upper right corner when logged in. If you don't have an account, please email admin@orshalom.org to get started.

Teen Hub will be held on Wednesdays from 6:30-7:30 on Zoom or at 3201 Ulloa St, San Francisco (the former Grace Luthern Church) beginning October 13, 2021.

Financial aid is available. Contact Lillian to start the process (admin@orshalom.org). Please fill out the form with the correct tuition and we will adjust it after financial assistance has been granted. Current members should renew their membership prior to enrollment. New members should fill out a membership form before registering students for school. You can become a member here. All tuition is due in full by 12/31/21. You may pay in installments. If paying by check or requesting financial aid, please choose the 'Bill my Account' option on the payment page.

You will receive an immediate email verification upon completing the enrollment process. If you don't receive one, your enrollment has not been received. Contact the office with any questions.

* Parent Name (first and last)

* Parent Email

* Student's Name (first and last)

* Student's Day School

* Student's date of birth

* Grade and Tuition

Please provide the following medical information about your child in case of an emergency:

* Has your child received the Covid-19 vaccination? (We understand that children under 12 are not eligible for the Covid-19 vaccine at this time.)

* My child's vaccinations are up to date:

* Insurance Provider

* Insurance ID

* Physician Name

* Physician Phone Number

Allergies, relevant medical conditions, and actions to take:

My child carries an EpiPen

Or Shalom requires 2 non-parental/guardian emergency contacts.

* Emergency Contact #1

* Emergency Contact #1 Phone

* Emergency Contact #2

* Emergency Contact #2 Phone

Sat, October 23 2021 17 Cheshvan 5782