Religious School Registration 2024-2025 / 5785

Religious School Registration 2024-2025 / 5785

Welcome!

On behalf of the Education Committee, I look forward to a year of joyful community-building and meaningful Jewish learning. It is going to be a great year!

If you have any questions, feel free to contact me at: rabbijanine@testl.org, work phone: (314) 432-5877 x3, or cell phone: (206) 658-3702.

L'shalom - In peace,

Rabbi Janine Schloss

P.S. Please note that only the fields with the * are required.

Parent/Guardian Information

Parent/Guardian #1 Full Name*

Parent/Guardian #1 Email*

Parent/Guardian #1 Cell*

Street Address*

Home Phone

City*

State*

Zip*

Parent/Guardian #2 Full Name

Parent/Guardian #2 Email

Parent/Guardian #2 Cell

Street Address

Home Phone

City

State

Zip

Student(s) lives with

Name of shared or non-custodial parent, address, email, and cell #

Should School information be sent to this parent?

Does this parent have permission to pick up your child(ren) from Religious School?

Emergency Authorization #1 Name*

Relationship*

Phone:*

Phone:

Emergency Authorization #2 Name*

Relationship*

Phone:*

Phone:

Emergency Medical Information

Doctor's Name

Doctor's Phone

Student #1

Student #1 First Name*

Student #1 Last Name*

Student #1 Grade in Fall 2024*

Student #1 School in Fall 2024*

Student #1 Birthday*

DD/MM/YYYY

Student #1 Email

Student #1 Cell

Student #1 Hebrew Name

Student #1 Preferred Pronouns

Wondering what this is? Check this out: https://reformjudaism.org/why-pronouns-are-so-important-and-why-using-right-ones-so-jewish

Insurance Company and Name of Insured

Group Number

Policy Number

Does your child have any special learning needs or learn best in any specific types of educational settings? If yes, please describe:

Does your child have any special behavioral or emotional issues we can help support? If yes, please describe:

Does your child have an IEP or 504 Plan? If yes, please describe:

Does your child have any other special issues or needs? If yes, please describe:

Health History:

	NO	YES
Allergies (food, medicines, etc.)
Anaphylactic allergies*
Asthma
Diabetes
Epilepsy/Seizures
Hearing Problems
Vision Problems

If the answer to any of the above is YES, please explain and list what accommodations your child might need:

Does your child take medication of any kind? If yes, please give the name of the medication and its purpose:

Is there anything else your child's teacher should know regarding their health condition?

Are there any other issues that are life threatening, require medication, or should be brought to our attention?

*Has your child been prescribed epinephrine or an EpiPen?

If YES, an EpiPen and an allergy action plan MUST be provided to Temple Emanuel. Please call Rabbi Janine for our allergy action form.

Do you have another student to register?*

Student #2

Student #2 First Name*

Student #2 Last Name*

Student #2 Grade in Fall 2024*

Student #2 School in Fall 2024*

Student #2 Birthday*

Student #2 Email

Student #2 Cell

Student #2 Hebrew Name

Student #2 Preferred Pronouns

Wondering what this is? Check this out: https://reformjudaism.org/why-pronouns-are-so-important-and-why-using-right-ones-so-jewish

Insurance Company and Name of Insured

Group Number

Policy Number

Does your child have any special learning needs or learn best in any specific types of educational settings? If yes, please describe:

Does your child have any special behavioral or emotional issues we can help support? If yes, please describe:

Does your child have an IEP or 504 Plan? If yes, please describe:

Does your child have any other special issues or needs? If yes, please describe:

Health History:

	NO	YES
Allergies (food, medicines, etc.)
Anaphylactic allergies*
Asthma
Diabetes
Epilepsy/Seizures
Hearing Problems
Vision Problems

If the answer to any of the above is YES, please explain and list what accommodations your child might need:

Does your child take medication of any kind? If yes, please give the name of the medication and its purpose:

Is there anything else your child's teacher should know regarding their health condition?

Are there any other issues that are life threatening, require medication, or should be brought to our attention?

*Has your child been prescribed epinephrine or an EpiPen?

If YES, an EpiPen and an allergy action plan MUST be provided to Temple Emanuel. Please call Rabbi Janine for our allergy action form.

Do you have another student to register?

Student #3

Student #3 First Name*

Student #3 Last Name*

Student #3 Grade in Fall 2024*

Student #3 School in Fall 2024*

Student #3 Birthday*

Student #3 Email

Student #3 Cell

Student #3 Hebrew Name

Student #3 Preferred Pronouns

Wondering what this is? Check this out: https://reformjudaism.org/why-pronouns-are-so-important-and-why-using-right-ones-so-jewish

Insurance Company and Name of Insured

Group Number

Policy Number

Does your child have any special learning needs or learn best in any specific types of educational settings? If yes, please describe:

Does your child have any special behavioral or emotional issues we can help support? If yes, please describe:

Does your child have an IEP or 504 Plan? If yes, please describe:

Does your child have any other special issues or needs? If yes, please describe:

Health History:

	NO	YES
Allergies (food, medicines, etc.)
Anaphylactic allergies*
Asthma
Diabetes
Epilepsy/Seizures
Hearing Problems
Vision Problems

If the answer to any of the above is YES, please explain and list what accommodations your child might need:

Does your child take medication of any kind? If yes, please give the name of the medication and its purpose:

Is there anything else your child's teacher should know regarding their health condition?

Are there any other issues that are life threatening, require medication, or should be brought to our attention?

*Has your child been prescribed epinephrine or an EpiPen?

If YES, an EpiPen and an allergy action plan MUST be provided to Temple Emanuel. Please call Rabbi Janine for our allergy action form.

Do you have another student to register?

Student #4

Student #4 First Name*

Student #4 Last Name*

Student #4 Grade in Fall 2024*

Student #4 School in Fall 2024*

Student #4 Birthday*

Student #4 Email

Student #4 Cell

Student #4 Hebrew Name

Student #4 Preferred Pronouns

Wondering what this is? Check this out: https://reformjudaism.org/why-pronouns-are-so-important-and-why-using-right-ones-so-jewish

Insurance Company and Name of Insured

Group Number

Policy Number

Does your child have any special learning needs or learn best in any specific types of educational settings? If yes, please describe:

Does your child have any special behavioral or emotional issues we can help support? If yes, please describe:

Does your child have an IEP or 504 Plan? If yes, please describe:

Does your child have any other special issues or needs? If yes, please describe:

Health History:

	NO	YES
Allergies (food, medicines, etc.)
Anaphylactic allergies*
Asthma
Diabetes
Epilepsy/Seizures
Hearing Problems
Vision Problems

If the answer to any of the above is YES, please explain and list what accommodations your child might need:

Does your child take medication of any kind? If yes, please give the name of the medication and its purpose:

Is there anything else your child's teacher should know regarding their health condition?

Are there any other issues that are life threatening, require medication, or should be brought to our attention?

*Has your child been prescribed epinephrine or an EpiPen?

If YES, an EpiPen and an allergy action plan MUST be provided to Temple Emanuel. Please call Rabbi Janine for our allergy action form.

Permission Forms

Photography: Temple Emanuel has permission to use photographs or video of school and youth engagement activities in which my child(ren) may appear in the presentation of TE programs to the TE and greater St. Louis Jewish communities and on TE's website and social media for the 2024-25 school year.

I hereby*

Emergency Contact & Medical Release: Permission is granted for the 2024-25 school year to render first aid, should the need arise. In the event I cannot be reached in an emergency, I hereby give permission to the physician selected by Temple Emanuel or its representative to hospitalize, secure treatment for, and to order injection, anesthesia, or surgery for my child(ren) as named previously. I further agree to waive all legal cause of action against those permittees mentioned above. I agree to hold harmless the above-named organization and its administration, teachers, aides and any person involved in any outing for an injury that might occur during an outing or special activity. In the case of any legal action, I agree to indemnify said personnel for the costs of any legal actions brought as a result of injury to the previously-named child(ren) on any such outing. In the event of a medical emergency while my child(ren) is participating in a school trip, I authorize Temple Emanuel and its representatives to release previously submitted medical information, including information concerning allergies, medical conditions, and regular medications, to the healthcare provider. I understand Temple Emanuel officials will use the contact information provided upon registering for the 2024-25 Religious School year to contact me in the event of such emergency. If any emergency medical procedures or treatments are required during the trip, I consent to the trip supervisors(s) arranging for and consenting to the procedures or treatment in the supervisors' discretion. I will pay the costs of any such medical procedure and treatment.

I hereby*

Field Trip Release: My child(ren) has permission to participate in activities and outings planned by the Temple Emanuel Religious School during the 2024-25 school year. I give permission for my child(ren) to travel with the Temple Emanuel personnel, teachers, parents and adult drivers as applicable to provide necessary transportation for the outing. When privately-owned vehicles are used for transporting students, only the vehicle owner's liability coverage is applicable to any vehicular accident. I understand that school trips may be cancelled when necessary by the Senior Rabbi, Rabbi Educator, Executive Director, Youth Advisor, teacher or Board of Trustees. Temple Emanuel cannot guarentee reimbursement when such cancellations occur. Parents/guardians will be notified of any significant change in plans prior to the school/youth group trip.

I understand the the following is expected of my child(ren): to follow instructions given by the teacher/chaperone; not to leave or separate from the group without appropriate authorization from a teacher/chaperone; to comply with all school and Temple Emanuel policies and rules of conduct.

In the event that any of the above expectations are violated, I understand Temple Emanuel officials reserve the right to remove the student from the trip and the student may be sent home at the parent's expense and/or be subject to disciplinary consequences.

If the trip includes water-related activities (such as swimming, diving, etc.) or any participation on amusement park rides, I acknowledge the inherent risks in these acitivities and give my express permission for my child(ren) to participate in those activities.

I understand that if I have not granted permission for the above prior to a school trip, my child(ren) will not be permitted to participate and will remain at school in a supervised activity.

Therefore, I hereby release, indemnify, and hold harmless Temple Emanuel and its teachers and volunteers assocated with the school trip from any and all liability in connection with any injury (including any injury caused by negligence), in conjunction with the school trip.

I request that the above-named child(ren) be allowed to participate in all planned field trips for the 2024-25 school year and specifically consent to their participation.

I hereby*

Signature*

Date*

Payment

Tuition for 2024-2025 / 5785

Kindergarten and 1st Grade: $220

2nd - 8th Grades: $335

9th and 10th Grades: $180

Additional Fee for Optional 3rd - 6th Grade Hebrew: $300

I would like to pay*

Please note that TE does not want finances to be a barrier to your child's Jewish education. Contact Rabbi Janine at rabbijanine@testl.org or (314) 432-5877 x3 if there is something we can do for your family.

Today's Payment

USDIf paying with a credit card, enter the amount you are paying today (please consider adding 3% to cover our credit card fees) and fill out the credit card information below. To pay with Venmo, enter "$0" as the amount and send your payment to @Temple-Emanuel-StL (don't forget the "-StL"!). To pay with a check, enter "$0" as the amount, make your check out to "Temple Emanuel," and mail it to Temple Emanuel, 12166 Conway Rd, St. Louis, MO 63141.

Credit Card

Shared or Non-Custodial Parent Information

Emergency Authorization Information

Student #1's Confidential Health History

Student #2's Confidential Health History

Student #3's Confidential Health History

Student #4's Confidential Health History

Credit Card