Midrasha

Name

This field is for validation purposes and should be left unchanged.

Temple Israel Religious School

2026-27 Registration

(1) Student Name(Required)

First Last

Hebrew Name

Name

Date of Birth(Required)

Grade Level(Required)

Select the grade level the student will be starting in Fall

School (if applicable)

Name of student's current or most recent school

Additional Student (optional)

Additional Student

I want to add an additional student

I do not want to add an additional student

(2) Student Name(Required)

First Last

Hebrew Name

Name

Date of Birth(Required)

Grade Level(Required)

Select the grade level the student will be starting in Fall

School (if applicable)

Name of student's current or most recent school

Parent Information

Parent/Guardian Name (1)

First Last

Home Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone Number

Work Phone Number

Cell Phone Number

Additional Parent/Guardian

I would like to add a second parent/guardian at the same address.

I would like to add a second parent/guardian at a different address.

I do not want to add a second parent/guardian

Parent/Guardian Name (2)

First Last

Home Address (if different from Parent (1))

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Home Phone Number

Work Phone Number

Cell Phone Number

Email Address(es) for information, updates, and student progress

Parent/Guardian Email Address(Required)

Enter Email Confirm Email

Parent/Guardian Email Address

Enter Email Confirm Email

PERSON TO CONTACT IF PARENT/PARENTS CANNOT BE REACHED

Contact(Required)

First Name Last Name

Relationship(Required)

(example, Grandparent, Friend)

Phone(Required)

Student's Physician(Required)

Phone Number(Required)

Pertinent Health information

Known Allergies or Pertinent Health information

Special Needs or Accommodations