2023-24 Religious School Registration - Form - Temple Israel of West Palm Beach

Temple Israel Religious School
2023-2023 ♦ 5784

__________________________________________________________

Our Mission

To inspire and nurture students in forming their Jewish identity and love of Jewish life, while providing a strong understanding of Reform Judaism. We do this through the teaching of Jewish holidays, lifecycle, Torah, and values, along with Hebrew, Shabbat, and Tikkun Olam (repair of the world) - always while deepening our connection to the land of Israel and its people.

Our Religious School provides an opportunity for friendships and community-building in an environment that welcomes students and families and encourages active participation. Our focus is to make learning attainable to all and to foster a love of Judaism and the Jewish people.

__________________________________________________________

Program Highlights

Religious School: Students will meet bi-weekly on Sunday morning for engaging and interactive learning experiences rooted in our values. Includes music, prayer, and hands-on activities.

Hebrew Instruction: All students in Grades 3-7 will also receive one-on-one or small group Hebrew instruction. Students will meet with our Director of Education, Beth Pennamacoor, meaning Hebrew learning and B’nai Mitzvah prep is individualized and you make your own schedule!

8th-12th Grade:

Chat & Chew w/ Rabbi Carlie and Rabbi Ryan for 8th-12th Graders

We'll eat together, have some fun, and explore challenging topics of our world and what Judaism has to say about them. Here's your chance to ask tough questions, argue, and form your own answers. Once a month on Sundays from 9:30am-10:30am - September 10, October 1, November 12, December 3, January 7, February 4, March 3, April 14, May 5

Madrichim (Teacher’s Assistants)

All 8th-12th graders have the opportunity to serve as madrichim, teacher’s assistants in our Religious School. Please click here to complete the madrichim application and learn more.

__________________________________________________________

Program Tuition

Kindergarten-2nd	Sunday Mornings	$475
3rd-7th*	Sunday Mornings + Hebrew (individual instruction)	$625
8th-12th	Sunday Mornings	$200

A Non-Refundable Deposit of $100/student is required & will be applied towards your tuition.

*B’nai Mitzvah fee is separate from Religious School and Hebrew School tuition. Please call Karen Szteinberg, Executive Director, at (561) 833-8421 for more info.

Questions? Contact Beth Pennamacoor, Director of Education & Youth Programming, at (561) 833-8421 or beth@temple-israel.com.

START HERE TO ENROLL YOUR CHILD(REN)

Are you paying in full, or only making a deposit on your Child(ren)'s tuition?

WHO'S BEING REGISTERED

* How many Students are being registered for Religious School?

STUDENT 1 INFORMATION

* Student 1 - New or Returning Student?

* Student 1 - GRADE /PROGRAM

Student 1 - First Name

Student 1 - Last Name

Student 1 - Hebrew Name

Student 1 - Date of Birth

Student 1 - Gender (Identifies as)

Student 1 - Secular School Attending (as of August 2023)

Grade as of August 2023

Student 1 - Additional Options

Youth Group Fee $36Teacher Appreciation Gift $18

STUDENT 1 – ֵEMERGENCY MEDICAL INFORMATION

Student 1 - Name of Physician

Student 1 - Physician Phone #

Student 1 - Date of child’s last tetanus shot

Student 1 - Allergies

Student 1 - Medications

Student 1 - Known Medical Conditions

STUDENT 2 INFORMATION

* Student 2 - New or Returning Student?

* Student 2 - GRADE /PROGRAM

Student 2 - First Name

Student 2 - Last Name

Student 2 - Hebrew Name

Student 2 - Date of Birth

Student 2 - Gender (Identifies As)

Student 2 - Secular School Attending (as of August 2023)

Grade as of August 2023

Student 2 - Additional Options

Youth Group Fee $36Teacher Appreciation Gift $18

STUDENT 2 – ֵEMERGENCY MEDICAL INFORMATION

Student 2 - Name of Physician

Student 2 - Physician Phone #

Student 2 - Date of child’s last tetanus shot

Student 2 - Allergies

Student 2 - Medications

Student 2 - Known Medical Conditions

STUDENT 3 INFORMATION

* Student 3 - New or Returning Student?

* Student 3 - GRADE /PROGRAM

Student 3 - First Name

Student 3 - Last Name

Student 3 - Hebrew Name

Student 3 - Date of Birth

Student 3 - Gender (Identifies As)

Student 3 - Secular School Attending (as of August 2023)

Grade as of August 2023

Student 3 - Additional Options

Youth Group Fee $36Teacher Appreciation Gift $18

STUDENT 3 – ֵEMERGENCY MEDICAL INFORMATION

Student 3 - Name of Physician

Student 3 - Physician Phone #

Student 3 - Date of child’s last tetanus shot

Student 3 - Allergies

Student 3 - Medications

Student 3 - Known Medical Conditions

STUDENT 4 INFORMATION

* Student 4 - New or Returning Student?

* Student 4 - GRADE /PROGRAM

Student 4 - First Name

Student 4 - Last Name

Student 4 - Hebrew Name

Student 4 - Date of Birth

Student 4 - Gender (Identifies As)

Student 4 - Secular School Attending (as of August 2023)

Grade as of August 2023

Student 4 - Additional Options

Youth Group Fee $36Teacher Appreciation Gift $18

STUDENT 4 – ֵEMERGENCY MEDICAL INFORMATION

Student 4 - Name of Physician

Student 4 - Physician Phone #

Student 4 - Date of child’s last tetanus shot

Student 4 - Allergies

Student 4 - Medications

Student 4 - Known Medical Conditions

PARENT 1 INFORMATION

Parent/Guardian 1 - Title

Parent/Guardian 1 - First Name

Parent Guardian #1 Last Name

Parent/Guardian 1 - Occupation

Street Address

City

State

Zip Code

Parent/Guardian 1 - Home Phone Number

Parent/Guardian 1 - Mobile Phone Number

Parent/Guardian 1 - Email Address

* Is there a second parent/guardian?

PARENT 2 INFORMATION

Parent/Guardian 2 - Title

Parent/Guardian 2 - First Name

Parent/Guardian 2 - Last Name

Parent/Guardian 2 - Occupation

Mailing Street Address

City

State

Zip Code

Home Phone Number

Mobile Phone Number

Email Address

ADDITIONAL FAMILY INFORMATION INFORMATION

Child(ren) live(s) with:

Both ParentsMotherFatherOther

Additional Information

Please share any additional information about your child(ren), including learning or behavioral issues, that would assist us in guiding his/her/their experience through our Religious school.

What are your hopes and dreams regarding your child(ren)'s religious education?

Please indicate if you are interested in learning more about leadership opportunities and joining our Religious School Committee.

EMERGENCY CONTACT INFORMATION

In case of emergency, if a parent/guardian cannot be reached, please notify:

* Name

* Relationship

* Phone Number

* Name

* Relationship

* Phone Number

INSURANCE & RELEASE INFORMATION

In the event of an emergency, the following information may be necessary in order for your child to receive emergency care at the emergency room:

Insurance Company Name

Insured's Name

Policy Number

Group Number

* I hereby give my consent to Temple Israel’s Educator, Rabbi, Administrator or Teacher to make available to my child professional emergency medical care and release any information that may otherwise be covered under HIPAA laws if such care is indicated. I give my permission for my child to receive proper medical care by any doctor, nurse, paramedic or member of a medical staff of a hospital licensed by the State of Florida. It is understood that a conscientious effort will be made to notify my spouse or other guardian to my child before such action is taken. It is further understood that every effort will be made to contact my child’s physician prior to any treatment. This certifies that my child is in good physical health and has my permission to participate in all activities that are part of the regular Religious School program.

I hereby give my consent to Temple Israel’s Educator, Rabbi, Administrator or Teacher to make available to my child professional emergency medical care and release any information that may otherwise be covered under HIPAA laws if such care is indicated. I give my permission for my child to receive proper medical care by any doctor, nurse, paramedic or member of a medical staff of a hospital licensed by the State of Florida. It is understood that a conscientious effort will be made to notify my spouse or other guardian to my child before such action is taken. It is further understood that every effort will be made to contact my child’s physician prior to any treatment. This certifies that my child is in good physical health and has my permission to participate in all activities that are part of the regular Religious School program.

* PICK-UP PERMISSION: In addition to the parents/guardians named on page one of this form, the following people have (or specifically do not have) permission to pick-up my child from Temple Israel and/or from any off-site Temple Israel Religious School/Youth Group program. I understand that it is my responsible to notify the school in writing of any changes.

PICK-UP PERMISSION: In addition to the parents/guardians named on page one of this form, the following people have (or specifically do not have) permission to pick-up my child from Temple Israel and/or from any off-site Temple Israel Religious School/Youth Group program. I understand that it is my responsible to notify the school in writing of any changes.

PHOTO/VIDEOGRAPHY RELEASE: I grant Temple Israel permission to use any photos, videos or other recordings – in print and electronically – taken at its services and/or programs for any legal use including but not limited to publicity, copyright purposes, illustration, advertising, web content and social media, and I waive any fee or other compensation.

List any exceptions

If there is a chance that your child will need an EpiPen, inhaler, Benadryl, etc. during school hours, please provide us with a sealed, unopened package of the medication, instructions, prescription and emergency contact information in a plastic ziplock bag with your child’s name on it.

Please check the box to acknowledge that you are registering for school at Temple Israel of West Palm Beach Florida. 1901 North Flagler Drive West Palm Beach, Florida 33407

Total Religious School Fees