Religious School Student Information

2023-2024 Religious School
Student Information Form

Please fill out one form per child enrolled in Religious School.

STUDENT INFORMATION

* Student's First Name

* Student's Last Name

Nickname

Student's Cell Phone

Student's Email

Student's Address

* Birthday

* Grade in Religious School for 2023-2024

* Returning Student?

YesNo

* Which day would you prefer to have your child attend Religious School?

TuesdaySunday

What size tshirt does your child wear?

* Name of Student's K-12 School for 2023-2024

* Pronouns

* Does your child have an Individualized Education Plan (IEP), a 504 plan, or learning or social needs that you would like to share with us?

* TBH Religious School may use pictures of my child taken during School and other Temple-sponsored activities for TBH's publications, website (www.tbhla.org) and/or social media platforms.

FAMILY INFORMATION

* Are you currently members of Temple Beth Hillel?

* Which temple membership category applies to your family?

* Guardian #1 First Name

* Guardian #1 Last Name

* Guardian #1 Cell Phone

* Guardian #1 Email

Guardian #2 First Name

Guardian #2 Last Name

Guardian #2 Cell Phone

Guardian #2 Email

* Guardian #2 Home Address (if different from Student's)

* Please send all correspondence to:

* During the year we often look to parents for support and guidance as we plan for the future of our program. Are you interested in participating in this manner?

* Throughout the year we may call on parents from various industries to help or participate in Religious School or Synagogue programming. Please share your work industry and/or special skills you have.

* As part of our ongoing work this year we have created programming for Jews of color (self identified as Asian, Black, African American, Latinx, other) - is your family or child interested in joining this programming?

Please list below any students that your child would like to be in class with (please separate with commas). Please be advised that a variety of factors are taken into account when class groupings are determined. We appreciate your understanding.

EMERGENCY INFORMATION

* Emergency Contact #1

Relationship to Student

Phone Number

* Emergency Contact #2

* Relationship to Student

Phone Number

* Emergency Contact #3

* Relationship to Student

* Phone Number

* Name of Student's Doctor (First & Last)

* Doctor's Phone Number

* Insurance Company

* Insurance Policy Number

* Insurance Phone Number

Please list any relevant information below. If none, write N/A.

* Student's Medical Conditions:

* Student's Medications:

* Student's Allergies:

Is there anything else you'd like us to know about your child?

Please list any adult who is not already listed as an Emergency Contact that has your permission to take your student home from TBH.

Agreement signature (please write full name and this shall serve as your legal signature)

* Guardian #1 Signature

Today's Date

Guardian #2 Signature

Today's Date

If you have any questions at all, please don't hesitate to reach out to Andrea Arons Jaffe in the Religious School office. aaronsjaffe@tbhla.org 818-763-9148 ext. 109

Fri, April 26 2024 18 Nisan 5784

Religious School Student Information

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