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Religious School Registration 5784
Temple Etz Chaim religious school registration for school year 2023 - 2024.

Religious school open to Temple Etz Chaim member families only. For information on joining our community, please visit our website temple-etzchaim.org or send a message to membership@temple-etzchaim.org.

Religious School tuition will be added to your ShulCloud account shortly after submitting this form.
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**Parent 1 is also the primary emergency contact**
Parent 1 Name *
Parent 1 Address *
(please include city/town or zip code)
Parent 1 Home Phone
**Parent 1's cell phone is the primary emergency contact method**
Parent 1 Cell Phone *
Parent 1 Work Phone *
Parent 1 Email Address *
Parent 2 Name
Parent 2 Address
(if different from Parent 1)
Parent 2 Home Phone
(if different from Parent 1)
Parent 2 Cell Phone
Parent 2 Work Phone
Parent 2 Email Address
Would you like your contact information shared with other parents? *
Child(ren) lives with: *
Student 1 Name *
Student 2 Name
Student 3 Name
Student 1 Hebrew Name
(in English)
Student 2 Hebrew Name
(in English)
Student 3 Hebrew Name
(in English)
Student 1 Public School Grade *
Student 2 Public School Grade
Student 3 Public School Grade
Student 1 - Name of Public School *
(e.g. Franklin High School, Horace Mann Middle School)
Student 2 - Name of Public School
(e.g. Franklin High School, Horace Mann Middle School)
Student 3 - Name of Public School
(e.g. Franklin High School, Horace Mann Middle School)
Student 1 - Special Learning Accommodations
(Please send an IEP, 504, or summary to directorofeducation@temple-etzchaim.org to help us support your child in their learning)
Student 2 - Special Learning Accommodations
(Please send an IEP, 504, or summary to directorofeducation@temple-etzchaim.org to help us support your child in their learning)
Student 3 - Special Learning Accommodations
(Please send an IEP, 504, or summary to directorofeducation@temple-etzchaim.org to help us support your child in their learning)
Student 1 - NEW to Religious School *
Student 2 - NEW to Religious School
Clear selection
Student 3 - NEW to Religious School
Clear selection
Student 1 - Medical Conditions and any medications taken *
(if none, please put n/a)
Student 2 - Medical Conditions and any medications taken
Student 3 - Medical Conditions and any medications taken
Student 1 - Allergies *
(if none, please put n/a)
Student 2 - Allergies
Student 3 - Allergies
Emergency contact name *
a person who is NOT living with the family to be contacted if parent(s) are unreachable
Emergency contact relationship to student *
(e.g. aunt, grandparent, friend of the family)
Emergency contact - home phone
Emergency contact - cell phone *
Medical Information - Name of Physician *
Medical Information - Physician phone number *
Medical Information - Insurance coverage *
is the family covered by family medical/hospital insurance?
Medical Information - Insurance name *
Medical Information - Group number
Medical Information - Policy/ID number *
Medical Information - Policyholder's name *
(e.g. parent name)
Medical Information - Waiver and consent *
In the event of an accident, we will not hold Temple Etz Chaim, its members or its staff legally responsible. In the event of a medical emergency, I hereby authorize Temple Etz Chaim's Religious School or anyone affiliated with it to authorize medical treatment and transport my child(ren) to the nearest medical facility.  My name below indicates my agreement.
Media Use Consent *
Temple Etz Chaim routinely promotes activities through various media sources.  This includes, but is not limited to, newsletters, newspapers, brochures, displays, emails, Temple Etz Chaim’s website and web pages.  In doing so, the pictures of congregants who are students of our Religious School may be included (names will not be used).  Temple Etz Chaim will not record remote learning sessions nor will screenshots or pictures taken during remote learning be distributed outside of the Temple.  I agree that my child(ren)'s picture may be used for any/all Temple Etz Chaim media.
Religious School tuition will be added to your ShulCloud account shortly after submitting this form.

Religious school open to Temple Etz Chaim member families only. For information on joining our community, please visit our website temple-etzchaim.org or send a message to membership@temple-etzchaim.org.
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