2023/24 Temple Sholom HaMakom Enrollment

Thank you for your interest in participating in HaMakom this year! We are asking you to provide your child's teachers, the clergy, and the administration the below information so that we can ensure that your child gets the best educational experience that we can provide for them.

Also, if you are logged in to your Temple Sholom Account, please make sure that the above box has your child's name in it and not yours. We want to make sure that the below information matches up to the correct person in our system. If you are enrolling multiple children for HaMakom, you will need to fill this form out for each child.

Thank you!

Registering for:

HaMakom 2023-24 ($100)8th Grade Core - L'Atid l'Avo - Future of Reform Judaism ($75)9th Grade Core - Jewish Values and Relationships ($75)Confirmation - Jewish Choices in History ($100)Jewish Journaling ($75)CPR Training ($36)First Aid ($36)All Temple Sholom enrollees must pay the Registration Fee once per school year; then the relevant class(es). Non-Temple Sholom, just choose the class(es) for which you want to register.

Student's Information

First Name

Last Name

Preferred Pronouns

Grade in the 2023/24 School Year

Which School do they go to?

Student's Email Address

By filling in your child's personal email address, you are giving us permission to email them about Religious School, Gesher, and/or haMakom events. If your child does not have a personal email address, or you do not feel comfortable with us emailing them, leave this field blank

Cell Phone

By filling in your child's cell phone number, you are giving us permission to call or text about Religious School, Gesher, and/or haMakom events. If your child does not have a cell phone, or you do not feel comfortable with us having their number, leave this field blank

May we correspond with this student (13 or older) through social media such as Facebook?

Photo Release

I give Temple Sholom and the HaMakom program permission to publish in print, electronic, or video format the likeness or image of my child(ren), including social media. I release all claims against the Temple with respect to copyright ownership and publication including any claim for compensation related to use of the materials.

Please write yes or no (depending on your stance on the above statement) and your name in the box above. Your name typed above will be treated as a signature.

Parent First Name

Parent Last Name

Parent Email

Emergency Contact's Name

Emergency Contact's Relationship to the Student

Emergency Contact's Cell Phone

Emergency Contact's Home Phone

Emergency Contact's Work Phone

Doctor's Name

Doctor's Phone Number

Does this student have any allergies we should be aware of? Please list.

Does this student have any special needs (learning-related, medical or otherwise) that we should be aware of? Please explain and consider providing a copy of their IEP or 504 plan, if applicable.

Does your child take any prescription medication(s) (e.g., anti-depressant, anti-seizure, anti-anxiety, mood stabilizer, etc)? If so, please explain how the medication helps them

Would you be willing to provide authorization for someone from the Temple religious school to contact this student's school teacher to discuss best practices related to classroom supports and accommodations?

If yes, please provide the teacher’s name and contact information

Is there any other information that you feel we should know in order to meet your child’s needs?

Sat, May 10 2025
12 Iyar 5785

Update this content.

Sat, May 10 2025 12 Iyar 5785

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