Religious School Registration for 2024-25 - Form

Please select your account in the box above and select a Religious School grade before submitting the form.

If you are paying by credit card, you will be billed 100% today. Otherwise, choose "Bill to my Account."

Confirmation email will be sent to:

ebloch@ourtemple.org

Are you a member of Temple Emanu-El?

Please Select OneYesNo

Parent Information

Parent 1 First Name

Parent 1 Last Name

Parent 1 Email

Parent 1 Cell Phone

Parent 1 Employer

Parent 1 Business Phone

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Cell Phone

Parent 2 Employer

Parent 2 Business Phone

Address

City

Zip

Photo Opt Out

Photo Opt OutIf you DO NOT wish your child(ren)'s picture to appear as part of a group in Temple Emanu-El's bulletin or other publications, please check this box.

Emergency Contacts

Emergency Contact Name

Emer. Contact's Relationship to Student

Emegency Contact Phone 1

Emergency Contact Phone 2

Emergency Contact Email

Emergency Contact Name

Emergency Contact's Relationship to Student

Emergency Contact Primary Phone Number

Emergency Contact Alternative Phone Number

Emergency Contact Email

Carpool Permission

Please check here if you are interested in carpooling with other families

Please list everyone that has permission to pick up your child in carpool.

Please note that we may ask for identification

Please list anyone that is prohibited from picking up your child and the relationship.

Please note that if the person you list is a parent, we may require you to supply us with appropriate documentation.

Student Information

* Student First Name

Student Last Name

Student Hebrew Name

Student prefers to be called

Student Birthdate

Secular School attending Fall 2024

* Grade in secular school - Fall 2024

* Religious School Grade Fall 2024

Students in grades 4-7 must register and attend Religious School to become a Bar/Bat Mitzvah.
Fees in those grades provide for instruction by both faculty and clergy.

Religious School Grade Fall 2024 Non-member

If other, please specify:

Student Email

All emails sent to students will be CC'd to parent

Please provide any additional information about your child regarding learning, social, or behavior issues that will help us offer the best possible school experience:

Medical Info and Release

* Medical Release & Liability

Medical Release & Liability I hereby grant permission for my child(ren) to participate in all Temple youth programs, activities and events and do release Temple Emanu-El and its representatives from all liability arising out of my child’s participation in such activities. In addition, I, the undersigned parent/guardian of the above child(ren), do further certify that my child(ren) is physically able to participate in such activities. By selecting 'I agree' below and by enrolling your child(ren) in Religious School at Temple Emanu-El, you indicate your agreement to the above terms and conditions

Does your child take any prescriptions or have any medical conditions that we should be aware of?

If you checked other in Allergies, please specify:

If your child carries an EpiPen, please make sure the teachers and staff are aware of where it can be found.

Payment Information

Amount Due for this Registration

Amount due for this registration. You must fill out and pay for each child separately. To register another child, complete this registration and submit it, then create a new registration form for each additional child. If you have an accommodation on file, accounting will adjust this amount.

* Payment Timing

Religious School Tuition may be paid in one payment in September or it can be paid monthly on the 1st of each month beginning in September with the last payment on February 1st. Any other arrangements must be in place prior to filling out this registration. If you are requesting accommodation, please click here and submit the forms prior to registration.

* Payment Method -

Please Select OneDraft from checking account (ACH) - If you have previously authorized drafts (ACH) from your checking and you wish to use that account, you do not need to resubmit account information.Credit CardAccommodation on FileCheckBill to account as Temple Beth-El Member

Name on Credit Card

Last 4 digits of Credit Card Number

Go here to make sure your credit card is on file: https://ourtemple.shulcloud.com/member/payment_methods

To register another child, submit this form and start a new form for additional each child.