2020/21 Religious School New Student Enrollment

Thank you for your interest in joining our Religious School! 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 Religious School experience that we can provide for them. We offer integrated and non-integrated options for students with special needs (Al Pi Darco program) in our Religious School programs, so please let us know what your child needs to thrive and succeed.
Also, 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.
Thank you!

Parent/Guardian Information

Parent/Guardian 1's First Name

Parent/Guardian 1's Last Name

Parent/Guardian 2's First Name

Parent/Guardian 2's Last Name

Parent/Guardian 1's Address

Parent/Guardian 2's Address

Parent/Guardian 1's Home Phone

Parent/Guardian 1's Cell Phone

Parent/Guardian 2's Home Phone

Parent/Guardian 2's Cell Phone

Parent/Guardian 1's Work Phone

Parent/Guardian 1's Email

Parent/Guardian 2's Work Phone

Parent/Guardian 2's Email

With whom does the child primarily live?

If Other, with whom does your child live and what is their address?

We have many families in our congregation with members who are of different faiths. While we require (along with the Union for Reform Judaism) that any child in our religious school only be actively educated in one faith tradition, we do respect that families celebrate differently. Please let us know any other faiths that may be practiced by members of the family - at home or related - so that we can be sure to be sensitive to your family's needs and practices.

Does your child have any prior religious school experience; where and how many years?

Emergency Contact's Name

Emergency Contact's Relationship to the Student(s)

Emergency Contact's Cell Phone

Emergency Contact's Home Phone

Emergency Contact's Work Phone

Doctor's Name

Doctor's Phone Number

Photo Release

I give Temple Sholom 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.

Student's Information

First Name

Last Name

Hebrew Name

Date of Birth

Grade in 2020/21

Preferred Pronouns

Email (8th Grade or up)

Cell Phone (8th Grade or up)

This student would like to receive text messages about Religious School or JU

May we correspond with this student (13 or older) through Facebook?

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

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

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

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

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

Thu, May 15 2025
17 Iyar 5785

Update this content.

Thu, May 15 2025 17 Iyar 5785

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