Religious School Registration For 2023-2024

If you have questions about the registration process, please contact Donna Mitchell, Lifelong Learning Administrative Assistant.

Please read the information below and complete the applicable form(s) to enroll your child in Religious School for the 2023-2024 academic year.

Brit Kehillah
Registration Policy
General Release

New members, please submit your Belonging Application BEFORE submitting this registration form.

Religious School Registration 2023-2024

A current Registration Form must be on file in the Lifelong Learning Office for a student to be enrolled.

Student(s)*
Click the + button to add a child.
Full Name Hebrew Name Date of Birth Grade as of 9-1-2023 Name of Public/Private School
Parent/Guardian 1 Name*
First Last
Parent/Guardian 1 Email*
Enter Email Confirm Email
Parent/Guardian 1 Mobile Phone*
Parent/Guardian 1 Home Phone - if different from mobile phone
Parent/Guardian 2 Name
First Last
Parent/Guardian 2 Email
Enter Email Confirm Email
Parent/Guardian 2 Mobile Phone
Emergency Contact Name*
First Last
Emergency Contact Phone Number*
Non-Refundable Registration Fee for Kindergarten-7th Grade
Registration fee is $100 for each Kindergarten-7th grade student.
Price: $100.00
Religious School Fee for Kindergarten-7th Grade
Religious School Fee is $400 for each Kindergarten-7th grade student.
Price: $450.00
Mid-week Hebrew (for 3rd-6th graders only; choose one option)
Required for 3rd-6th Graders. The online offering will take place in small groups with student/teacher availability determining day/time OR you can choose the in person classes which will take place at the Temple on Wednesdays.(7th Graders DO NOT attend mid-week Hebrew.)
Next Dor 8th-11th Grade
Program designed specifically for teens. Drop-In learning programs meet on Sundays and Wednesdays. (Please note, Ozrim in 8th-11th Grades are required to register for Next Dor.)
Price: $180.00
Total
This amount will be billed to your Temple Shalom account.
$0.00
Religious School Registration Policy & Fees*
By submitting this form, my family has read and agrees to abide by the policies set forth for Religious School Registration Policy & Fees.
I agree to the Religious School Registration Policy & Fees.
Brit Kehilah Rules*
By submitting this form, my family has read and agrees to abide by the rules of the Brit Kehilah.
I agree to the Brit Kehilah Policy.
General Release*
By submitting this form, my family has read and agrees to the General Release.
I agree to the General Release.
Photo Release--I consent to the use of images of anyone in our family as described below.
Privacy and Use of Images Families may be photographed or videotaped as they participate in Temple activities, or they may be recorded in Temple Shalom video stream programs. On occasion, these images, and the identity of the persons depicted, may be used by Temple Shalom for educational, instructional, development and/or informational purposes in print, internet and digital media, including in news releases (e.g, Texas Jewish Post) and/or printed publications or materials, electronic publications, or websites. Temple Shalom will not sell images of Temple Shalom members or non-members or their families to third parties, and it will not use their images for promotional or advertising purposes that do not concern Temple Shalom and its programs.
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FOR OFFICE USE ONLY
- Registration received date
- Registration Policy & Rules
- Brit Kehilah
- General Release
- Health/Medical Form if changes or new student
- Mid-week Online Learning Option

Religious School & Youth Programs Health Form 2023-2024

A new Health/Medical Form must be submitted if there are any changes to student's health/medications or if the student is new to our Religious School. If appropriate, please complete the separate Health/Medical Form below. Once completed, this form will remain in effect throughout your child's religious school education. Notify the Lifelong Learning Office of any medical changes. The more information you share, the better we are able to ensure the health and safety of your child.

Student(s) Name(s)*
Click the + button to add a student.
Name Grade as of 2023-2024
Parent(s)/Guardian(s)*
Click the + button to add a parent/guardian
Name Cell Phone
Email
Insurance Information
If the student(s) is/are covered by family/medical/hospital insurance, please complete this section.
Carrier/Plan Name Group Number Policy Number Carrier Address Claims/Phone Authorization Number Co-Pay Amount Name of Insured Relationship to Student(s)
Health History--Allergies
Please describe the reaction and management of the reaction.
Student(s) Name Medication Allergies Food Allergies Other Allergies
Health History--Education
Click the + button to add another child.
Student(s) Name Child receives an IEP: YES/NO Child has learning differences: YES/NO Tools that help my child learn
Prescription Medications Being Taken
Click on the + button to add another medication. Prescription medications must be in the original packaging bottle that identifies the prescribing physician, the name of the medication, the dosage, and the frequency of administration.
Student's Name Medication Dosage Specific times taken each day Reason for taking Side effects, if applicable
Over the Counter (OTC) Medications
Click on the + button to add another OTC medication. By submitting this form, I/We give permission for staff to dispense the following OTC medications (i.e., headache medicine, cough drops, decongestants, etc.) You must list all OTC medications that you approve. If a specific OTC medication is not listed above, staff will not dispense that medication.
Student's name OTC Medication approved
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Full Name	Hebrew Name	Date of Birth	Grade as of 9-1-2023	Name of Public/Private School

Name	Grade as of 2023-2024

Name	Cell Phone

Carrier/Plan Name	Group Number	Policy Number	Carrier Address	Claims/Phone Authorization Number	Co-Pay Amount	Name of Insured	Relationship to Student(s)