Religious School Registration for Pre-K through 12th Grade 2020-2021

Welcome to Online Religious School Registration!

Please help us plan for the upcoming year by registering your children as soon as possible. Please read the following documents before you complete and submit the form(s).

Introductory Letter
Registration Policy
Brit Kehilah
General Release
Religious School Calendar

Religious School Registration 2020-2021

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

Student(s)*
Full Name Hebrew Name Grade as of 9-1-2020 Name of Public/Private School
Emergency Contact Name*
First Last
Emergency Contact Phone Number*
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 1 Address*
Street Address City State / Province / Region ZIP / Postal Code
Parent/Guardian 2 Name
First Last
Parent/Guardian 2 Email
Enter Email Confirm Email
Parent/Guardian 2 Mobile Phone
Parent/Guardian 2 Address
Street Address City State / Province / Region ZIP / Postal Code

If same as Parent/Guardian 1, no need to fill in.
Tots Academy (2-4 year olds)
Price: $50.00 Quantity:
Meets monthly on Sunday mornings from 9:30-11:00am. Parental attendance is required. $50/child with parent.
Registration Fee for Kindergarten-12th Grade
Price: $100.00 Quantity:
Registration fee is $100 for each Kindergarten-12th grade student.
Religious School Fee for Kindergarten-12th Grade
Price: $400.00 Quantity:
Religious School Fee is $400 for each Kindergarten-12th grade student.
Mid-week Hebrew (3rd-6th graders; choose one option)
Required for 3rd-6th Graders. We will now be offering mid-week online learning for Hebrew. 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.)
Confirmation Fee
Price: $360.00 Quantity:
Confirmation (10th grade-covers portion of retreat, robes, pictures, flowers, reception) $360 per student.
Total
$0.00
This amount will be billed to your Temple Shalom account.
Religious School Registration Policy & Fees*
I agree to the 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.
Brit Kehilah Rules*
I agree to the Brit Kehilah Policy.
By submitting this form, my family has read and agrees to abide by the rules of the Brit Kehilah.
General Release*
I agree to the General Release.
By submitting this form, my family has read and agrees to the General Release.
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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

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)*
Name Grade as of 2020-2021

Click the + button to add a student.
Parent(s)/Guardian(s)*
Name Cell Phone

Click the + button to add a parent/guardian
Email
Insurance Information
Carrier/Plan Name Group Number Policy Number Carrier Address Claims/Phone Authorization Number Co-Pay Amount Name of Insured Relationship to Student(s)

If the student(s) is/are covered by family/medical/hospital insurance, please complete this section.
Health History--Allergies
Student(s) Name Medication Allergies Food Allergies Other Allergies

Please describe the reaction and management of the reaction.
Health History--Education
Student(s) Name Child receives an IEP: YES/NO Child has learning differences: YES/NO Tools that help my child learn

Click the + button to add another child.
Prescription Medications Being Taken
Student's Name Medication Dosage Specific times taken each day Reason for taking Side effects, if applicable

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.
Over the Counter (OTC) Medications
Student's name OTC Medication approved

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.
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Ruach--Youth Choir for 2nd-7th Graders

Come Make Music With Us! If you are in 2nd-7th grade, join Ruach, Temple Shalom’s Youth Choir, and sing songs, make friends and have fun! Choir will meet most Sundays immediately following Religious School. (A schedule will be provided) Submit this form when you submit your registration form.

Student(s)*
Name Grade as of 9-1-2020

Click the + button to add a student. Must be in 2nd through 7th grade to participate.
Email
Parent(s)/Guardian(s)*
Name Home Phone Cell Phone

Click the + button to add a parent/guardian.
CAPTCHA

Questions about the registration process? Email the Lifelong Learning Office at kthompson@templeshalomdallas.org.

Full Name	Hebrew Name	Grade as of 9-1-2020	Name of Public/Private School

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)

Student(s) Name	Medication Allergies	Food Allergies	Other Allergies