Religious School Registration

1. Read the Code of Conduct if you aren't familiar with it. By submitting this form, you and your child agree to abide by the terms of this code.
2. Fill out all applicable fields for one child
3. Press Submit at the bottom of the page
4. Make sure you see the following message below this instruction box

If you don't see the above message, check top of form for any missing fields and/or any other errors.

5. If you don't see "Thanks for submitting" check top of form for an error message such as

and/or a field circled in red with the message "please fill out this field". Complete any
required information and repeat steps 2-3 above.

Your E-Mail

* Student's Last Name

* Student's First Name

* birthdate (mm/dd/yy)

Emergency Contact/Permission to Pickup in Addition to Parent(s)

Member Parents only for emergency contacts and pickup permission1 non-parent emergency contact/pickup permission to list2 non-parent emergency contacts/pickup permissions to list3 non-parent emergency contacts/pickup permissions to list

NON-PARENT Emergency Contact/ Permission to Pick up: In the event of an emergency, we will try first to contact member parent(s). If you want anyone else to be contacted if you cannot be reached, or want others to be able to pick up your child at any time, select the number of contacts to list and then enter their names and up to 2 phone numbers per person in the fields that will be presented below.

List a couple as one person (i.e. Adam and/or Eve Goldstein.) No need to list any relationship information.

contact 1 name

contact 1 phone 1

contact 1 phone 2

contact 2 name

contact 2 phone 1

contact 2 phone 2

contact 3 name

contact 3 phone 1

contact 3 phone 2

Allergies

My child has no allergies requiring staff awarenessMy child has allergies which require staff awareness

* Current allergies

List above in a single line separated by commas. For example: tree nuts, fish

allergy severity

mild - no medication needednot severe: may need benedryl or medication listed below. Medication and instructions provided to school.severe - epipen and instructions provided to school

Check all that apply. You must bring in all indicated medications along with administration instructions by the first day of school.

food at school

my child knows what s/she may eat or drink and may eat food provided by schoolmy child may not eat or drink anything other than food sent by us or water

Medications

Staff need not be aware of any medications my child is takingStaff should know that my child is currently on the medications listed below

* current medications

Special Needs

My child has no special needs requiring staff awarenessMy child has special needs which require staff awareness

If your child has any physical, medical, learning, social or behavioral needs that we should be aware of; please check the box above and you will be provided with a space below to enter details. It is helpful for us to know what strategies work for behavior and learning in a classroom setting. We appreciate this information and will keep it confidential. If your child has an IEP or 504 Plan at school, please consider sharing it with us so that we can meet his or her needs. You can upload it below.

Upload IEP or 504 plan

confidential notes about special needs

You can copy and paste your notes from word or notepad.

Would you like us to contact you to arrange a confidential meeting to discuss any areas of concern prior to the start of the religious school year?

noyes

best contact phone or email

* Signature of Parent

My signature above affirms:

1. In an emergency, the Religious School has my permission to contact “911” and request the assistance of a rescue squad. The Religious School and the rescue squad have my permission to take my child to the emergency room of the nearest hospital. The rescue squad, hospital and its staff have my authorization to provide treatment necessary for the well-being of my child.

2. Temple Beth Am may photograph my child for anonymous (unlabeled) use in publicity, publications and/or our website unless I have notified the Temple otherwise.

3. My child and I have read and discussed the Code of Conduct and agree to abide by its terms.

4. My child and I agree to to follow all current Covid regulations required by Temple Beth Am.

Religious School Information Due August 15, 2024