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Torah School Registration

2012-2013 Student Information and Registration. For information about programs and curriculum, see Torah School page on temple Website

Student 1

* STUDENT 1

* First Name

Hebrew Name

* Birthdate

* Grade (as of Sept. 2012)

* Student Information, check all that apply

New Student

Continuing Student

Male

Female

* Student 1 Email

Which study program do you choose? (See registration materials for descriptions)

Monday Night

Wednesday Night

Individualized Learning

A Combination of the Above You will be registered in Monday Night

Students may request two friends to be with in class. We do our best to place them with at least one mutual request.

Tuition Payments

Pre School (per session) $750.00

Grades 1-3 $1,000.00

Grades 4-6 $1,100.00

Grades 7-8 $1,400.00

Medical History...medications, allergies and physical challenges

Learning difficulties (visual, perceptual, attention,emotional, etc.) that might affect your childs experience. It helps us to know about special services he or she may receive. We appreciate copies of IEPs and 504 plans.

Student 2

* Student 2 Name

Student 2 Tuition

Pre School (per session) $750.00

Grades 1-3 $1,000.00

Grades 4-6 $1,100.00

Grades 7-8 $1,400.00

Family Information

FAMILY INFORMATION

* Parent 1 Name

* Address

* City, St, Zip

* Home Phone

* Cell Phone

* Email address

STANDARD PERMISSION

Please check all that apply

I give The Temple Religious School permission to escort my children within walking distance of their classes to school activities.

I give permission for my child's photo to be used in the Temple bulletin and website with or without his/her name.

I give permission for our name address and phone number to be included and distributed on a grade level roster to encourage Temple friendships.

EMERGENCY CONTACTS (* required fields, use NA if not applicable)

IN CASE PARENTS CANNOT BE REACHED WHO MAY WE CONTACT IN CASE OF EMERGENCY AND/OR TO PICK UP YOUR CHILD/REN

* Emergency Contact 1 Name and Relationship

* Emergency Contact 1 Phone 1

* Emergency Contact 2 Name and Relationship

In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for 1) the administration of any treatment deemed necessary by the by a licensed physician or dentist and 2) the transfer of the child to any hospital reasonably accessible. This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.

Yes

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