Religious School 2023-24 Registration - Form

Temple Sholom Religious School is back for 2023-24!

Religious School Grades Pre K - 8th

2023/2024 School Year - Important Dates
Opening Day - September 10, 2023
Closing Day - May 5, 2024

Registration Form For Religious School
Pre-Kindergarten (age 4) - 8th Grade

How many children are you registering for Religious School?

Please Select OneOneTwoThreeIf you are registering more than 3 children, please call the Temple Office at 513-791-1330

Parent/Guardian Information:

* Parent/Guardian 1: First Name

* Parent/Guardian 1: Last Name

* Relationship of Parent/Guardian 1 to the child:

* Street Address of Parent/Guardian 1

Email address for Parent/Guardian 1:

Cell phone for Parent/Guardian 1:

Parent/Guardian 2: First Name

Parent/Guardian 2: Last Name

Relationship of Parent/Guardian 2 to the child:

Street Address of Parent/Guardian 2

Email address for Parent/Guardian 2:

Cell phone for Parent/Guardian 2:

* Name of First Child

First Child - Date of Birth

Please enter your child's Hebrew name (if known):

* First Child - What grade will your child be in this fall?:

Name of Second Child

Second Child Date of Birth

Second Child - please enter your child's Hebrew name (if known)

* Second Child - What grade will your child be in this fall?:

Third Child - Date of Birth

Third Child - please enter your child's Hebrew name (if known)

Third Child - What grade will your child be in this fall?:

As part of Temple Sholom's religious school curriculum, all 3rd through 7th-grade students are eligible and highly encouraged to enroll in weekly online Hebrew tutoring. We've partnered with Online Jewish Learning to offer our students one-on-one online Hebrew learning throughout the school year. Families and students will be matched with one of the many Jewish educators to choose a time that works with your weekly schedule. Please indicate below whether you elect to "opt-in" to this valuable experience for your child this year. The generosity of the Jewish Foundation of Cincinnati partially subsidizes online Hebrew learning.

If your child(ren) are in grades 3rd through 7th, do you elect to enroll them in weekly online Hebrew tutoring for the 2023-24 academic school year?

YesNoWhen enrolling your children to participate in online Hebrew learning, I understand a $250 per student fee will be added to my religious school tuition to cover associated costs.

Temple Sholom Use of Images in the Media:

Temple Sholom, its employees, or agents have the right to take photographs, videotape, or digital recordings ("Images") of me or my child and to use these in any and all media exclusively for the purpose of communicating the educational activities of the Temple. I do hereby release to Temple Sholom, its agents, and employees all rights to exhibit this work in print and electronic form publicly or privately. I wave any rights, claims, or interest I may have to control the use of my image in whatever media used. Child last names will not be used with media images.

* Use of Images in Media

Please Select OneYes, I do hereby consent and agree with the statement below and allow the use of images of myself or my child in the media.No, I do not consent to the use of images of myself or my child in the media.

Consent for Emergency Medical Treatment

* Emergency Treatment Consent

Yes, I give my consent for emergency medical treatment of my child as outlined belowNO, I do NOT give my consent for emergency medical treatment of my child.

IF REASONABLE ATTEMPTS TO REACH ME FAIL, I HEREBY GIVE MY CONSENT FOR:
1. The administration of any treatment deemed necessary by the medical professionals I have listed as my child's physician in the "emergency contacts" section of this enrollment form.
2. If my designated medical professional is not available, by another medical professional; and
3. The transfer of my child to any hospital reasonably accessible.

Parent/Legal Guardian Name:

Please enter the name of the parent or legal guardian who completed Consent for Emergency Medical Treatment

Additional Information about the first child:

* Does this child have an IEP, 504 Plan, or other academic plan in place in their secular school?

Please Select OneYesNo

* If yes, please provide information on your child's academic plan:

* Is there anything we need to know or be sensitive to concerning the emotional or behavioral well-being of this child?

Please Select OneYesNo

If yes, please provide information on your child's emotional or behavioral well-being.

* Does this child have any food allergies or any other health concerns that could affect them at Religious School??

Please Select OneYesNo

If yes, please provide specific information on your child's food allergies or conditions:

If your child has a food allergy, we require that an unopened EpiPen pack along with instructions and contact phone numbers be provided to the Temple Sholom office in a plastic zip-lock bag.

If there is a chance that your child will need medication, such as an inhaler for asthma, during school hours, please provide the Temple Sholom office with an unopened package of the medication, instructions and contact phone numbers in a plastic zip-lock bag.

Please share any other information that will help us create a safe, effective, and meaningful educational experience for your child:

Emergency Contact Information:

Name of child's Primary Physician

Phone number of child's Primary Physician

Name of child's Dentist

Phone number of child's Dentist

Primary Emergency Contact

Please enter the name of an emergency contact who is not a Parent/Guardian of the child.

Relationship to Primary Emergency Contact

For example: Aunt, Uncle, Cousin, or friend

Primary Emergency Contact Phone Number

Secondary Emergency Contact

Please enter the name of an emergency contact who is not a Parent/Guardian of the child.

Relationship to Secondary Emergency Contact

For example: Aunt, Uncle, Cousin, or friend

Emergency Secondary Contact Phone Number

Consent for Emergency Medical Treatment for the Second Child

Emergency Treatment Consent

Yes, I give my consent for emergency medical treatment of my child as outlined belowNO, I do NOT give my consent for emergency medical treatment of my child.

Parent/Legal Guardian Name:

Please enter the name of the parent or legal guardian who completed Consent for Emergency Medical Treatment for the 2nd child.

Additional Information about the second child:

* Does your 2nd child have an IEP, 504 Plan, or other academic plan in place in their secular school?

Please Select OneYesNo

* If yes, please provide information on your 2nd child's academic plan:

* Is there anything we need to know or be sensitive to concerning the emotional or behavioral well-being of this child?

Please Select OneYesNo

If yes, please provide information on your 2nd child's emotional or behavioral well-being.

* Does your 2nd child have any food allergies or any other health concerns that could affect them at Religious School??

Please Select OneYesNo

If yes, please provide specific information on your 2nd child allergies and conditions:

If your child has a food allergy, we require that an unopened EpiPen pack along with instructions and contact phone numbers to be provided to the Temple Sholom office in a plastic zip-lock bag.

If there is a chance that your child will need medication, such as an inhaler for asthma, during school hours, please provide the Temple Sholom office with an unopened package of the medication, instructions and contact phone numbers in a plastic zip-lock bag.

Please share any other information that will help us create a safe, effective, and meaningful educational experience for your 2nd child:

* Is ALL of the Emergency Contact information for the second child the same as for the first child?

Please Select OneYesNoThis includes: Primary Physician, Dentist, and 2 non-parent/guardian emergency contacts.

Emergency Contact Information for the second child:

Second Child - Name of child's Primary Physician

Second Child - Phone number of child's Primary Physician

Second Child - Name of child's Dentist

Second Child - Phone number of child's Dentist

Second Child - Primary Emergency Contact

Please enter the name of an emergency contact who is not a Parent/Guardian of the child.

Second Child - Relationship to Primary Emergency Contact

For example: Aunt, Uncle, Cousin, or friend

Second Child - Primary Emergency Contact Phone Number

Second Child - Secondary Emergency Contact

Please enter the name of an emergency contact who is not a Parent/Guardian of the child.

Second Child - Relationship to Secondary Emergency Contact

For example: Aunt, Uncle, Cousin, or friend

Second Child - Secondary Emergency Contact Phone Number

Third Child - Date of Birth

Third Child - Please enter your child's Hebrew name (if known):

* Third Child - What grade will your child be in this fall?:

Consent for Emergency Medical Treatment for the Third Child

Emergency Treatment Consent

Yes, I give my consent for emergency medical treatment of my child as outlined belowNo, I do NOT give my consent for emergency medical treatment of my child.

Parent/Legal Guardian Name:

Please enter the name of the parent or legal guardian who completed Consent for Emergency Medical Treatment for the 3rd child.

Additional Information about the third child:

* Does your 3rd child have an IEP, 504 Plan, or other academic plan in place in their secular school?

Please Select OneYesNo

* If yes, please provide information on your 3rd child's academic plan:

* Is there anything we need to know or be sensitive to concerning the emotional or behavioral well-being of this child?

Please Select OneYesNo

If yes, please provide information on your 3rd child's emotional or behavioral well-being.

* Does your 3rd child have food allergies or any other health concerns that could affect them at Religious School?

Please Select OneYesNo

If yes, please provide specific information on your 3rd child's health concerns.

Please share any other information that will help us create a safe, effective, and meaningful educational experience for your 3rd child:

* Is ALL of the Emergency Contact information for the third child the same as for the first and/or second child?

Please Select OneYesNoOnly choose "Yes" if ALL of the information (Primary Physician, Dentist, and both Emergency Contacts) are exactly the same.

* Please choose from below:

Please Select OneEmergency Contact Information is the same as the First ChildEmergency Contact Information is the same as the Second Child

Emergency Contact Information for the third child:

Third Child - Name of child's Primary Physician

Third Child - Phone number of child's Primary Physician

Third Child - Name of child's Dentist

Third Child - Phone number of child's Dentist

Third Child - Primary Emergency Contact

Please enter the name of an emergency contact who is not a Parent/Guardian of the child.

Third Child - Relationship to Primary Emergency Contact

For example: Aunt, Uncle, Cousin, or friend

Third Child - Primary Emergency Contact Phone Number

Third Child - Secondary Emergency Contact

Please enter the name of an emergency contact who is not a Parent/Guardian of the child.

Third Child - Relationship to Secondary Emergency Contact

For example: Aunt, Uncle, Cousin, or friend

Third Child - Secondary Emergency Contact Phone Number

Total Tuition for all children:

The above amount is the total for Religious School Tuition for all children registered
Tuition For First Child:
Pre-Kindergarten through 2nd Grade: $400.00
3rd Grade through 8th Grade: $600.00

I will pay my tuition as follows:

Please Select OneI will pay by credit card - please charge the card linked to my ShulCloud AccountI will pay by credit card - I will call the office (513.791.1330) to provide the card informationl will pay by check - I will send my check to the Temple OfficePlease charge my ShulCloud accountMy family would benefit from a scholarship

Please note that finances will never stand in the way of your child's Religious Education at Temple Sholom. If you would benefit from or would like to discuss a scholarship, please let us know by checking the Scholarship option above and someone from our office will be in touch.

For any other questions or assistance, please call our office at 513.791.1330.

Thank you!