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RELIGIOUS SCHOOL ENROLLMENT
AND
FAMILY CONTACT INFORMATION FORM 2013-2014

* Family Name

FIRST DAY OF RELIGIOUS SCHOOL: SUNDAY, SEPTEMBER 8, 2013

Student 1

* First Name

* Last Name

* Birthday

Allergy and/or Health Issue

Student 2

First Name

Last Name

Birthday

Allergy and/or Health Issue

Student 3

First Name

Last Name

Birthday

Allergy and/or Health Issue

Student 4

First Name

Last Name

Birthday

Allergy and/or Health Issue

Family Information

* Parent 1 Name

Parent 2 Name

* Home Address

* City

* Zip

* Home Phone Number

* Home Email Address

Parent 1 Work Phone Number

Parent 1 Work Email Address

Parent 1 Cell Phone Number

Parent 2 Work Phone Number

Parent 2 Email Address

Parent 2 Cell Phone Number

Enter the name of person, other than a parent, to contact in an emergency.

* Name

* Relation to Student

* Home Phone

* Cell Phone

To insure accurate record keeping and maintain good communications, please inform the Temple Office, the Religious School Principal or the Rabbi immediately when there is a change of address, telephone numbers or email addresses. Thanks for your cooperation.

Religious School Fees

The mission of the Religious School program at Temple B'nai Israel is to educate our children in the traditions, rituals, practices, language, history, beliefs and values of our Jewish faith.

Student Name(s), Program(s)

* Enter Number of Students

Thank you for your Payment.

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Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

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