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* 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.

Please upload an image of the students registered on this form. (Note that the file should be a jpeg, gif, or png format.)

Are you paying over several months

I would like to pay the balance in installments with the first transaction processed today.