Religious School

Registration Form

We would be happy to be partners with you in your children’s Jewish Education. Temple Judea is proud to be a congregation that engages families to have an active role in Jewish Tradition.

Student 1

Name

First Name

Last Name

Hebrew Name

Birthdate

YYYY

Grade (Fall 2025)

Secular School

Student 2

Name

First Name

Last Name

Hebrew Name

Birthdate

YYYY

Grade (Fall 2025)

Secular School

Student 3

Name

First Name

Last Name

Hebrew Name

Birthdate

YYYY

Grade (Fall 2025)

Secular School

Student 4

Name

First Name

Last Name

Hebrew Name

Birthdate

YYYY

Grade (Fall 2025)

Secular School

Parent Information - 1

Name

First Name

Last Name

Address

City, State, ZIP

Home Phone

(###)

###

####

Work Phone

(###)

###

####

Cell Phone

(###)

###

####

Parent Information - 2

Name

First Name

Last Name

Address

City, State, ZIP

Home Phone

(###)

###

####

Work Phone

(###)

###

####

Cell Phone

(###)

###

####

Emergency Contact

Name

First Name

Last Name

Relationship

Cell Phone

(###)

###

####

Home Phone

(###)

###

####

Alternative Contacts

The following people are authorized to pick up my child from Temple Judea Religious School & Activities

Name

First Name

Last Name

Cell Phone

(###)

###

####

Name

First Name

Last Name

Cell Phone

(###)

###

####

Name

First Name

Last Name

Cell Phone

(###)

###

####

Publicity Permission

Dropdown

I give my child, a student at Temple Judea Religious School, permission to be photographed for use in publicity for the Temple Judea website, Facebook page, The Scroll, Megillat Yehudah, L’Chayim, and any other publications approved by the congregation.

Name

First Name

Last Name

Date

YYYY

Transportation Permission

Dropdown

I hereby give permission for my child to be transported by bus, car, or other means of transportation approved by the Education Department, for any educational event conducted during the Religious School year. In consideration for transporting my child for any educational event, I and my child hereby knowingly and freely waive any and all causes of possible action and liability, etc. which I and my child have or acquire against Temple Judea, its Board of Directors, employees, and agents thereof. I hereby agree that as long as Temple Judea, its Board of Directors, and its agents/employees act in reasonable and responsible manner, my child and I will not hold them responsible for any consequences that may arise related to that transportation.

Name

First Name

Last Name

Date

YYYY

Health Care Administration Permision

Dropdown

I give my child, a student at Temple Judea Religious School, permission to attend all activities sponsored by the school. In case of an emergency, I hereby give permission to the physician selected by the school to hospitalize, secure treatment for, order injection, anesthesia or surgery for my child, after first attempting to contact me and the above named doctor, if time permits.

Name

First Name

Last Name

Date

YYYY

Medical / Healthcare Information

Name of Physician

Health Insurance Company

Physician's Phone Number

(###)

###

####

Insurance Phone Number

(###)

###

####

Insurance Policy/Group #

Allergies or healtcare needs, medications and treatments

Epipen

Should the use of medical device like an Epipen, insulin, or an inhaler be required

Will the student have it in their possession?

Can the student administer the treatment to themselves?

Will the school have it in their possession?

Student Educational Plan

This information will be used to help is create the best possible environment for the success of your child.

504 - IEP

Does your child have a 504 Plan or IEP in school?

Transitions

Does your child have difficulty with transitions?

Others

Is your child an accelerated / gifted learner?

Other information

What else can you tell us about the behavior, learning style, or social needs of your child?

Tell us about your child

Name

First Name

Last Name

Grade

Gender

What are your child’s interests/likes/hobbies?

What does your child enjoy?

What are your child’s strengths?

What are your child’s challenges?

What motivates your child?

Please share three words that describe your child

Anything else you’d like us to know about your child?

Religious School

Registration Form

Temple Judea Conservative Synagogue