2012-2013 Temple Israel Hebrew School Registration

TEMPLE ISRAEL HEBREW SCHOOL

REGISTRATION 2012-2013

PARENT INFORMATION:

Parent

Name(s)________________________________________________________________________

Parent & Child

Address ________________________________________________________________________________

Home Phone: __________________ Work Phone: __________________

Email Address: _________________

Cell phone: ____________________________

Other Parent: _____________________________Phone ___________________Cell Phone ______________

Other Address: __________________________________________________________________________

Email Address: q Check here for an additional mailing to second address

Emergency Contact Person: ________________________________________________________________

Relationship to child: ___________________Phone: ________________

CHILD INFORMATION

Child's Name: __________________________ Birthdate:___________________

Hebrew Name: Religious School Class (2012-2013)________________

Name of Elementary or Jr.High: _______________________________Grade as of Sept. 2012 __________

CHILD INFORMATION

Child's Name: _______________________ Birthdate __________________

Hebrew Name: Religious School Class (2011-2012)________________

Name of Elementary or Jr.High: _______________________________Grade as of Sep.2012 __________

CHILD INFORMATION

Child's Name: ________________________ Birthdate _________________

Hebrew Name: Religious School Class(2011-2012)________________

Name of Elementary or Jr.High: _______________________________Grade as of Sept. 2012 __________

GRANDPARENTS

(So they may be included in mailings to continue the Grandparents Fund)

Name _________________________________ Name _____________________________________

Address

PARENTS:

We need your help to make your child’s religious school experience at Temple Israel a good one. Please check off all of the activities to which you can contribute some time. Also, let us know your interests. We appreciate all the time you make available!

Name:____________________________________

Phone:_____________________________Email:__________________________________

1: Classroom

_____ Room Parent

_____ Volunteer Substitute

_____ Hebrew Tutoring

_____ Parent Group Coordination

2: Committee Work

_____ Education Committee

_____ Fundraising

_____ Helping with Special Programs

3: Other

Please describe:

____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Thank you!

MEDICAL RELEASE

I give the Temple Israel Education Director, Janice Colbert, or her appointed designee, permission to authorize emergency medical treatment for my child(ren):

Name(s) _________________________________________________,

______________________________________________

This permission is given with the understanding that the school will, if possible, attempt to reach me prior to any action. I authorize the school to administer first aid on site, if necessary. I agree to be responsible for the costs of any medical care so delivered.

Date __________________

Signature _________________________________________________________

Insurance Company ___________________________________

Policy No. __________________________

Group No. __________________________

Primary Care Physician Or Pediatrician ______________________________________

Phone _____________________________

In the space below, please note any medical issues that we should know about (eg., allergies, sensitivity to stings, etc.)

PHOTO RELEASE

Temple Israel of Greenfield may use my child(ren)’s pictures in publications for any purpose which may include, among others, advertising, promotion, marketing and packaging service to serve and promote interests of the Temple.

_____Agree

_____Disagree

EDUCATIONAL FIELD TRIP WAIVER

My child(ren) has/have permission to go on educational field trips sponsored by Temple Israel. I understand that they will travel by bus or private car and will be accompanied by staff and parents. I release Temple Israel from all responsibility for injury during supervised activities.

Name(s) of child(ren) ________________________________________ , ____________________________________________

Signature of Parent ___________________________________________Date _______________________

NOTE: The Temple Israel staff will inform you of upcoming field trips with, minimally, a note sent home with your child(ren).

In order to be able to meet student’s needs in the best way possible, we need to know about any special needs or learning issues. In the space below, please attach a paragraph (or more) containing information that you feel that we should have about your child(ren). Please include information regarding special interests, learning and environmental needs, or anything that will help us plan for your child’s experience in Religious school.

I have read the tuition fee policy and will comply with payments to the Temple for 2011-2012 school year.

Signed ________________________________

Parent(s)

ATTENDANCE REQUIREMENTS:

I/We are aware of the Education Committee policy about the importance of attendance and will make every effort to ensure that my/our child comes to class regularly. It is the policy of the Education Committee that a student must attend 75% of all class meetings to be promoted.

In the event that prolonged illness or other circumstances endanger fulfillment of this requirement, parents should contact the teacher or education director.

It is the responsibility of the student and his/her parent(s) to contact the school for make-up work. It is further, the obligation of the student to make up missed work as the year progresses in order to fulfill the requirements to be promoted.

Please notify us if you know in advance that the child will miss one or more classes.

Signed _______________________________________________

Parent(s)

Date _________________________________________________