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Section A: Family Contact Information
* State (Primary)--Select State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Section B: Student Enrollment Information
* Student 1 Grade in Religious SchoolPlease Select One Kindergarten 1st-Grade 2nd-Grade 3rd-Grade 4th-Grade 5th-Grade 6th-Grade 7th-Grade 8th-Grade 9th-Grade 10th-Grade 11th-Grade 12th-Grade
Student 1 Allergy/Medication Details Please describe allergies and medications with dosage and timing.
* Student 2 Grade in Religious SchoolPlease Select One Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th
Student 2 Allergy/Medication Details Please describe allergies and medications with dosage and timing.
* Student 3 Grade in Religious SchoolPlease Select One Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th
Student 3 Allergy/Medication Details Please describe allergies and medications with dosage and timing.
* Student 4 Grade in Religious SchoolPlease Select One Kindergarten 1st 2nd 3rd 4th 5th 6th 7th 8th 9th 10th 11th 12th
Student 4 Allergy/Medication Details Please describe allergies and medications with dosage and timing.
By signing my name below, my child(ren) have permission to participate in the Religious School at Temple Beit HaYam. In consideration of my child(ren)'s acceptance as a religious school student, I hereby waive any and all claims against Temple Beit HaYam, its agents and its employees that may arise out of any injury, loss or damage suffered by my child(ren) during any religious school activity. I hereby authorize the Cantor/Education Director, or person designated by the Education Director, to obtain emergency medical care for my child(ren) in the event such care is indicated. I give my permission for my child(ren) to receive emergency medical care by any nurse, doctor, paramedic, emergency responder, or member of a medical staff of a hospital licensed by the State of Florida. I understand that every effort will be made to notify a parent/guardian prior to treatment.
From time to time your child’s photo may be taken in our classrooms or special events. We use these photos in the synagogue newsletters, on our synagogue website as well as our Facebook groups and other publicity materials.
Section D: Payment Information
For all 6th and 7th grade families:
OPTIONAL: Hinei Mah Tov Directly after regular Sunday Religious School, students will be invited to stay for a couple more hours, watch a fun movie, have pizza, play games, and just have fun. This will be a supervised but otherwise unstructured period solely to encourage our students to form and maintain Jewish friendships and to love coming to their Temple. All donations will be used to defray the cost of food and drinks, movies, games, and other supplies. Suggested Donations: $90, $180, or $270 per child
Total 5784 Religious School Amount Due:
