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Temple Israel Youth Learning Registration 2019-2020

We are pleased that you have chosen to register your children at Temple Israel for the 2019-2020 school  year. We look forward to a year of learning and growing together! 
 
Please complete the information below as the first step in your registration process. The payment process is noted at the end of the form. 

Family Information

Parent 1

Parent 2

(If Different)

Children's Information

Child 1

(If s/he has one)

Yes
No
Yes
No - (NOTE: this must be discussed with educator before child can begin school)
Parent 1
Parent 2
Both Parents
Other

We want to be sure that we offer each of your children the most successful learning and social environment possible. As our partners in this effort, we ask that you respond openly to the following questions, knowing that we have your child's best interests at heart. ALL INFORMATION WILL BE KEPT IN THE STRICTEST CONFIDENCE.

HEBREW LEARNING and PRAYER EXPLORATION

If your child will be in 4th grade or higher, please answer the following questions so that we can enroll him/her in the appropriate Hebrew Learning class. If you have questions, contact Jackie Klein at [email protected]

Yes
No
Yes
No

Child 2

(If s/he has one)

Yes
No
Yes
No - (NOTE: this must be discussed with educator before child can begin school)
Parent 1
Parent 2
Both Parents
Other

HEBREW LEARNING and PRAYER EXPLORATION

If your child will be in 4th grade or higher, please answer the following questions so that we can enroll him/her in the appropriate Hebrew Learning class. If you have questions, contact Jackie Klein at [email protected]

Yes
No
Yes
No

Child 3

Yes
No

(If s/he has one)

Yes
No - (NOTE: this must be discussed with educator before child can begin school)
Parent 1
Parent 2
Both Parents
Other

HEBREW LEARNING and PRAYER EXPLORATION

If your child will be in 4th grade or higher, please answer the following questions so that we can enroll him/her in the appropriate Hebrew Learning class. If you have questions, contact Jackie Klein at [email protected]

Yes
No
Yes
No
Permissions
Names
Child(s) Grades
Home Address
Home Phone
Parents' Cell Phone
Parents' Email Addresses
Yes
No
Religious School Fees

LATE FEE OF $36/CHILD FOR ALL REGISTRATIONS OF RETURNING STUDENTS RECIEVED AFTER JULY 31ST.

PreK - Grade 1 $54
Grade 2 - Grade 3 $180
Grade 4 - Grade 7 $360

PAYMENT OPTIONS

To pay in full using Credit Card or Electronic Check (ACH), please refer to the Payment Information section at the bottom of this form. NOTE: A 3% PROCESSING FEE IS ADDED TO ALL CREDIT CARD PAYMENTS

To set up automatic recurring payment installments using a Credit Card or Electronic Check (ACH) please refer to the installment payment question at the bottom of this form.

Emergency Medical

In case of emergency, if parents cannot be reached please notify one of the following:

Medical Personnel Contact Information

In the event of an emergency, the following information may be necessary in order for your child to receive emergency care at the emergency room of the nearest hospital:

Signature
*Membership at Temple Israel

If you are not currently a Temple Israel member, we look forward to welcoming you and your family into the congregation. Please contact our Temple Administrator, Karen Szteinberg ([email protected]). Our membership rates vary depending upon the age of the adults in the family. Families who are joining as their children begin Religious School are gifted with their first year of Temple Israel membership as long as their oldest child is under grade 4. TEMPLE ISRAEL WILL NOT TURN AWAY ANY FAMILY DUE TO FINANCIAL NEED. If you need special arrangements, please speak with Karen Szteinberg, our Temple Administrator, as soon as possible.

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

  

Total:   

For added Security please check the box below.