Apply

Welcome to the HAC Portal!

If you need assistance, please contact the Registrar, Mrs. Esther Keller at (216) 382-3300 ext.372 or email registration@hac1.org. For camp registration please email campstep@hac1.org

Application For Non 22-23 HAC Student

PLEASE NOTE: If your child is currently enrolled in HAC for 2022-2023, please apply for camp in the forms section of the parent portal. Please do not use this application.

Applicant

Current Grade

Gender

Male

Female

First Name

Last Name

Date of Birth

Please upload an image of the applicant (optional)

Choose file

Current School

Does your child currently receive any accomodations or modifications in school?

Yes

Is there anything else we should know about your child?

Parent Information

Father is Deceased

Mother is Deceased

Parents Divorced?

Yes

Parents Separated?

Yes

Father

Title

First Name

Last Name

Home Address

Address

City

State

Zip

Home Phone Number

Work Phone Number

Mother

Title

Mother First

Maiden Name

Work Phone Number

Other Information

My child will be residing with someone else (non-parent) during camp.

Emergency Contacts

ALL EMERGENCY CONTACTS MUST LIVE WITHIN ONE HOUR OF SCHOOL. Parents cannot be listed as emergency contacts. Any person listed should be able to assist in contacting you. The people listed must be able to take responsibility for the child in case the parents cannot be reached and should be at least 18 years of age.

Emergency Contact 1

Name

Relationship to Child

Home Number

Cell Number

Address (Including City, State & Zip)

Emergency Contact 2

Name

Relationship to Child

Home Number

Cell Number

Address (Including City, State & Zip)

Physician

Name

Phone Number

Dentist

Name

Phone Number

Medical Condition

Does your child have an ongoing medical problem?

Has your child been treated in the past year for a major illness or injury?

Seasonal Allergies

Does your child have any seasonal allergies?

Medication Allergies

Does your child have any medication allergies?

Medications

My child is currently on medication.

Consents and Signature

By entering my electronic signature below I affirm to make payments in accordance with the payment plan chosen above. I also affirm that all registrations are final and no refunds will be provided. If a payment is returned unpaid, my signature gives Hebrew Academy of Cleveland permission to debit my account electronically for the original amount plus a service fee of $25.00. Please make sure sufficient funds are available to avoid any complications regarding this policy. The Hebrew Academy reserves the right to process any payment that falls on a weekend, on the preceding Friday.

I have reviewed all the medical data above and all the infomation is accurate. In the event of an emergency when I, or my pediatrician, cannot be reached, I give permission to the physician or hospital selected by HAC to secure proper treatment for my child, with the understanding that I will be notified as soon as possible. I give permission to the school's administration to release any relevant medical information, as appropriate, to those handling the medical emergency.

We hereby grant permission for our child to participate in all field trips. We understand that adequate and appropriate supervision will be provided. In the event of an injury requiring medical attention, I hereby grant permission to the staff to attend to my child. If the injury warrants further medical attention, I expect every effort will be made to contact me to receive my specific authorization before action is taken. If efforts to contact me are unsuccessful, I grant permission for necessary medical treatment to be given. In addition, I hereby give my permission to the supervising staff to take my child to the physician, dentist, or to the hospital if an accident or serious illness occurs on the trip and I cannot be located. WAIVER We recognize, however, that unanticipated situations and problems can arise on any trip, school-sponsored or otherwise, which situations or problems are not reasonably within the control of the staff. We further agree to release and hold Hebrew Academy of Cleveland Camp STEP (HAC), its agents, officers, employees, and volunteers, from any and all liability, claims, suits, demands, judgments, costs, interest and expense, (including attorneys’ fees and costs) arising from such activities, including any accident or injury to the student and the costs of medical services, or any cause beyond the control of HAC, including, but not limited to, natural disasters, civil disturbances, acts of terrorism, and wars.

Electronic Signature

Date

PLEASE NOTE: All registrations are final. No refunds can be provided. You will receive an acceptance decision within 2 weeks. Submission of this application does not guarantee acceptance into camp. Additionally, tuition balances need to be resolved before acceptance into camp.

Application For Non 22-23 HAC Student

Applicant

K'tan Tan Division Forms

K'tan Tan Division Forms

K'tan Tan Division Forms

K'Tan Tan Division

Current School

Parent Information

Father

Father's Spouse (if applicable)

Home Address

Mother

Mother's Spouse (if applicable)

Home Address

Other Information

Emergency Contacts

Physician

Dentist

Medical Condition

Food Allergies

Treatment Options

Seasonal Allergies

Treatment Options

Medication Allergies

Treatment Options

Epipen

Medications

Payment Information

Total Due:

Consents and Signature