2013 - 2014 Temple Oheb Shalom Religious School Registration
Parent and Family Information
*First Name Primary Parent/Guardian  
*Last Name Primary Parent/Guardian  
Informal Name or Nickname  
*Relationship to Student(s):  
*First Parent E-Mail:   Valid e-mail is required
*Primary / Home Phone:   Format: 410-555-5555
*Cell Phone:   Format: 410-555-5555
Would You Like to Be Contacted VIA Text Message for School Closings and Other Important or Emergency Notifications?
*Primary Parent/Guardian Text?
YES
NO
*Home Address:  
*City:  
*State:  
*Zip Code:  
*Are You a Member of Temple Oheb Shalom:  
First Name Second Parent/Guardian  
Last Name Second Parent/Guardian  
Informal Name or Nickname:  
Relationship to Student(s)  
Second Parent E-Mail:   Valid e-mail is required
Primary / Home Phone (if different from above):   Format: 410-555-5555
Cell Phone:   Format: 410-555-5555
Would You Like to Be Contacted VIA Text Message for School Closings and Other Important or Emergency Notifications?
Second Parent/Guardian Text?
YES
NO
Address(if different from above):  
City:  
State:  
Zip Code:  
Emergency Contact Information (In The Event a Parent/Guardian Cannot be Reached) :
*Emergency Contact First Name:  
*Emergency Contact Last Name:  
*Home Phone:  
Cell Phone:  
*Address:  
*City:  
*State:  
*Zip Code:  
Registration and Permission Information
By registering our child(ren) below, we agree to make every effort to attend all scheduled classes, programs, and events and agree to pay school tuition as per the published or agreed upon fee schedule.
PLEASE CLICK HERE FOR THE CURRENT FEE SCHEDULE
I also hereby give permission for my child(ren) to accompany his/her/their class on Religious School field trips during the school year. I also give permission for my child(ren) to be transported to and from the field trip site. I understand that should a trip be planned in which I do not wish my child(ren) to participate, I can contact the Religious School office to have my child(ren) excluded.
***SELECTION REQUIRED BELOW***
I give permission for my chid(ren) to be photographed/video-taped/interviewed for publicity by Temple Oheb Shalom during the school year:
*
Yes No 
*Please Note* All students are subject to photography/video-tapping for educational purposes or for any reason in large group settings.
 
I would like my contact information as stated above to be included in the Parent Directory that will be distributed to all families in the Religious School. Please Include: (check all that apply)
Name  
Address  
Phone  
E-mail  
Other/Alternative Information to Include in the Directory   If Different From Above
Please DO NOT include any of my information in the Parent Directory  
 
My signature below confirms that the information provided herein is true and complete. The student(s) listed below has (have) my permission to engage in all school activities except as noted. The school has my permission to provide routine first aid, and seek emergency medical or dental treatment. If the student is not covered by medical and/or dental insurance, I agree to pay all costs incurred for emergency treatment. In the event of a medical or dental emergency, the school may transport the student for treatment. In the event of an emergency where none of the adults listed above are available, I authorize and give my consent to the school to obtain any necessary medical or dental treatment, including hospitalization and surgery, from a licensed health care provider or facility. This form may be photocopied for school-sponsored trips.
Parent/Guardian Electronic Signature
***REQUIRED***
*Parent Guardian Electronic Signature:  
*Number of Students Registering for Temple Oheb Shalom Religious School:  
Student 1 Information
*Student`s First Name:  
*Student`s Last Name:  
Student`s Informal Name or Nickname:  
Is This Child New To Temple Oheb Shalom Religious School?
*Please Choose:
Yes
No
FIRST TIME STUDENT?
*Registering for Religious School Grade:  
*Student`s Date of Birth:    Format: mm/dd/yyyy
*Student`s Gender:  
*Student`s T-Shirt Size:  
Student`s E-Mail (optional)  
For Those Students Who Have thier Own E-Mail Adress (Optional)
(Student E-Mails Will Not Be Included In The Directory)
*Student`s Secular School Attending in 2013 - 2014:  
*Student`s Grade in Secular School for the 2013 - 2014 School Term:  
Student`s Photo   Optional
Photo is Optional and Used for Identification Purposes Only
Student`s Classmate/Friend Request  
*Please Note* Every effort will be made to honor your child`s request. Requested are honored for all classes in grades K-3, and for Judaic classes only in grades 4-6.
Student 1 Health and Safety Information
Does this student have any potentially life threatening allergies (at risk for Anaphylaxis)?
* Life Threatening Allergy?
Yes
No
 
If there are any other special circumstances or considerations pertaining to the heath and/or well-being of this child at Temple Oheb Shalom Religious School please provide a brief explanation below.
 
*Please Note* Temple Oheb Shalom Does Not Hold or Store Student Medications or Prescriptions Including Epi-pens. Please send and necessary emergency medications (i.e. Asthma Inhaler, Epi-Pen, Benadryl, etc.) EACH and EVERY school session with your child.
STOP! - IF YOU ARE ONLY REGISTERING ONE STUDENT FOR RELIGIOUS SCHOOL PLEASE SCROLL DOWN TO THE END OF THE FORM AND PRESS SUBMIT.
Student 2 Information
Student 2 First Name:  
Student 2 Last Name:  
Student 2 Informal Name or Nickname  
Is Student 2 New To Temple Oheb Shalom Religious School?
Student 2 Registering for Religious School Grade:  
Student 2 Date of Birth:    Format: mm/dd/yyyy
Student 2 Gender:  
Student 2 T-Shirt Size:  
Student 2 E-Mail (optional)  
For Those Students Who Have thier Own E-Mail Adress (Optional)
(Student E-Mails Will Not Be Included In The Directory)
Student 2 Secular School Attending in 2013 - 2014:  
Student 2 Grade in Secular School for the 2013 - 2014 School Term:  
Student 2 Photo   Optional
Photo is Optional and Used for Identification Purposes Only
Student 2 Classmate/Friend Request  
*Please Note* Every effort will be made to honor your child`s request. Requested are honored for all classes in grades K-3, and for Judaic classes only in grades 4-6.
Student 2 Health and Safety Information
Does this student have any potentially life threatening allergies (at risk for Anaphylaxis)?
 
If there are any other special circumstances or considerations pertaining to the heath and/or well-being of this child at Temple Oheb Shalom Religious School please provide a brief explanation below.
 
*Please Note* Temple Oheb Shalom Does Not Hold or Store Student Medications or Prescriptions Including Epi-pens. Please send and necessary emergency medications (i.e. Asthma Inhaler, Epi-Pen, Benadryl, etc.) EACH and EVERY school session with your child.
STOP! - IF YOU ARE ONLY REGISTERING TWO STUDENTS FOR RELIGIOUS SCHOOL PLEASE SCROLL DOWN TO THE END OF THE FORM AND PRESS SUBMIT.
Student 3 Information
Student 3 First Name:  
Student 3 Last Name:  
Student 3 Informal Name or Nickname:  
Is Student 3 New To Temple Oheb Shalom Religious School?
Has Student 3 Attended Any Religious School in the Past?
Student 3 Registering for Religious School Grade:  
Student 3 Date of Birth:    Format: mm/dd/yyyy
Student 3 Gender:  
Student 3 T-Shirt Size:  
Student 3 E-Mail (optional)  
For Those Students Who Have thier Own E-Mail Adress (Optional)
(Student E-Mails Will Not Be Included In The Directory)
Student 3 Secular School Attending in 2013 - 2014:  
Student 3 Grade in Secular School for the 2013 - 2014 School Term:  
Student 3 Photo   Optional
Photo is Optional and Used for Identification Purposes Only
Student 3 Classmate/Friend Request  
*Please Note* Every effort will be made to honor your child`s request. Requested are honored for all classes in grades K-3, and for Judaic classes only in grades 4-6.
Student 3 Health and Safety Information
Does this student have any potentially life threatening allergies (at risk for Anaphylaxis)?
 
If there are any other special circumstances or considerations pertaining to the heath and/or well-being of this child at Temple Oheb Shalom Religious School please provide a brief explanation below.
 
*Please Note* Temple Oheb Shalom Does Not Hold or Store Student Medications or Prescriptions Including Epi-pens. Please send and necessary emergency medications (i.e. Asthma Inhaler, Epi-Pen, Benadryl, etc.) EACH and EVERY school session with your child.
STOP! - IF YOU ARE ONLY REGISTERING 3 STUDENTS FOR RELIGIOUS SCHOOL PLEASE SCROLL DOWN TO THE END OF THE FORM AND PRESS SUBMIT.
Student 4 Information
Student 4 First Name:  
Student 4 Last Name:  
Student 4 Informal Name or Nickname:  
Is Student 4 New To Temple Oheb Shalom Religious School?
Has Student 4 Attended Any Religious School in the Past?
Student 4 Registering for Religious School Grade:  
Student 4 Date of Birth:    Format: mm/dd/yyyy
Student 4 Gender:  
Student 4 T-Shirt Size:  
Student 4 E-Mail (optional)  
For Those Students Who Have thier Own E-Mail Adress (Optional)
(Student E-Mails Will Not Be Included In The Directory)
Student 4 Secular School Attending in 2013 - 2014:  
Student 4 Grade in Secular School for the 2013 - 2014 School Term:  
Student 4 Photo   Optional
Photo is Optional and Used for Identification Purposes Only
Student 4 Classmate/Friend Request  
*Please Note* Every effort will be made to honor your child`s request. Requested are honored for all classes in grades K-3, and for Judaic classes only in grades 4-6.
Student 4 Health and Safety Information
Does this student have any potentially life threatening allergies (at risk for Anaphylaxis)?
 
If there are any other special circumstances or considerations pertaining to the heath and/or well-being of this child at Temple Oheb Shalom Religious School please provide a brief explanation below.
 
*Please Note* Temple Oheb Shalom Does Not Hold or Store Student Medications or Prescriptions Including Epi-pens. Please send and necessary emergency medications (i.e. Asthma Inhaler, Epi-Pen, Benadryl, etc.) EACH and EVERY school session with your child.


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