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Religious School Information Due July 31, 2018

Submit a  separate form for each child in religious school.
    Forms will not be processed until your membership is renewed.   If you weren't sent here after completing membership renewal please go here first and renew your membership.
1. Fill out all applicable fields for one child
2. Press Submit at the bottom of the page
3. 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
4.  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.
   5.  If enrolling more than one child, click here to get a form for them.


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.

Placement Requests

We will try to place your child with up to two friends, since we believe that being with friends allows children to experience meaningful Jewish community. We cannot guarantee that large groups can be kept together. All religious school and membership forms must be received by 7/31/18 in order for placement requests to be considered. Enter below no more than TWO names of children to try to place with your child.

do not enter more than 1 name above

do not enter more than 1 name above

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

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

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 copy and paste your notes from word or notepad.

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(ren) and I have read and discussed the Code of Conduct and agree to abide by its terms.


Wed, June 19 2019 16 Sivan 5779