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Temple Shalom Religious School Registration 21-22

Please note:  You will be asked for your child(ren)'s Medical Insurance Information.  It may be helpful to have it handy.

Student Information

Most recently attended

Most recently enrolled

If yes, please explain.

Most recently attended

Most recently enrolled

If so, please explain

Most recently attended

Most recently enrolled

If so, please explain

Most recently attended

Most recently enrolled

If yes, please explain.

Please indicate the names, ages and religion of other children in your family who are not currently enrolled in the Religious School.

Child(ren)'s Current Residence Information


Parent/Guardian Information

(if different from above)

Second Parent/Guardian Information


Emergency Contact Information
(Other than Parent/Guardian listed above)


Medical Information

Name, Address, Phone Number

Name, Address, Phone Number

In the event it becomes necessary to bring your child to a hospital for diagnosis or emergency treatment, the Temple Shalom Religious School has my full permission to do so. In the event I am not able to be reached, I give my permission to any medical attendant in charge to provide all necessary emergency treatment should the need arise.

I, as parent/guardian, will assume full responsibility for such arrangements including payment of expenses incurred thereby and shall indemnify and hold harmless Temple Shalom and the Temple Shalom Religious School, teachers, professionals, employees, and staff as well as adult leaders and volunteer parents from any and all liability with respect thereto. 


Family Media Release Policy

During the course of the school year, many of our activities are photographed and video recorded for internal use on our website and social media accounts. We never use names or include personal information that would identify any of our students (The sole exception being the use of first names used with permission for the Rabbi's "B'nai Mitzvah Selfies). On some occasions, news media (print, television, etc.) may wish to film or photograph a school event and may request such information. We will only allow this with written consent from parents, which we will seek prior to the event.

Sun, October 17 2021 11 Cheshvan 5782