Registration Form for Review

Name

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

Student 1 Information

First Name(Required)

Preferred Name / Nickname

Date of Birth(Required)

Student Cell Phone (if applicable)

Student Email (if applicable)

School Currently Attending

If transferring, name of previous synagogue/school

Student 2 Information

First Name(Required)

Preferred Name / Nickname

Date of Birth(Required)

Student Cell Phone (if applicable)

Student Email (if applicable)

School Currently Attending

If transferring, name of previous synagogue/school

Parent / Guardian Information

Parent / Guardian 1

Relationship to Student

Email Address (primary)

Preferred Contact Method

Employer / Occupation (Guardian 1)

Parent / Guardian 2

Relationship to Student

Email Address (primary)

Preferred Contact Method

Employer / Occupation (Guardian 2)

Custody / Household Notes (optional)

Emergency Contacts

List two contacts (other than parents/guardians) authorized to pick up up the student in an emergency.

Emergency Contact 1

Relationship to Student

Emergency Contact 2

Relationship to Student

Health & Medical Information (Student 1)

This information is kept strictly confidential and used only to ensure your child's safety

Physician / Pediatrician Name

Alergy details & reactions (foods, medications, environmental, etc.):

Condition / Special needs details

Additional health notes or accommodations needed

Health & Medical Information (Student 2)

This information is kept strictly confidential and used only to ensure your child's safety

Physician / Pediatrician Name

Alergy details & reactions (foods, medications, environmental, etc.):

Condition / Special needs details

Additional health notes or accommodations needed

Program & Tuition Information

Tuition rates below are for the 2026-2027 academic year. Membership in Temple Israel is required for enrollment.

Program	Grades	Annual Tuition
Early Childhood	Pre-K – K	$180
Elementary & Middle School	1st – 6th	$360
High School / Teen Program	7th – 12th	N/C

Financial assistance is available. Please contact the synagogue office confidentially for information about our scholarship program

Permissions & Acknowledgements for Student 1

Permissions & Acknowledgements for Student 2

Parent / Guardian Signature

By signing below, I acknowledge that I have read and agree to the Temple Israel Religious School policies, including the Code of Conduct and Media Release terms as described above.

Registration Form for Review

Temple Israel Religious School Registration (1)

Student 1 Information

Student 2 Information

Parent / Guardian Information

Emergency Contacts

Health & Medical Information (Student 1)

Health & Medical Information (Student 2)

Program & Tuition Information

Permissions & Acknowledgements for Student 1

Permissions & Acknowledgements for Student 2

Payment Method

Credit Card Information

Billing Information

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