14 Tammuz 5779 |

Wednesday, July 17, 2019

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Temple Sinai

Saratoga Springs, New York

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Religious School Registration Form

Step 1 of 7

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PARENT / GUARDIAN INFORMATION
Parent 1 Name*
First Last
Parent 1 Address*
Street Address City State / Province / Region ZIP / Postal Code
Parent 1 Home Phone
Parent 1 Cell Phone
Parent 1 Email*
Is there a second parent or guardian?*
- Yes
- No
Parent 2 Name
First Last
Same home address and phone as above?
- Yes
- No
Parent 2 Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Parent 2 Home Phone
Parent 2 Cell Phone
Parent 2 Email

STUDENT INFORMATION
How many children are you registering?*
Please enter a number from 1 to 4.
If you are registering more than four children, please contact the Director of Education.
Child lives with...
- Both parents or guardians
- Parent or guardian 1
- Parent or guardian 2
Children live with
- Both parents or guardians
- Parent or guardian 1
- Parent or guardian 2
First Child Information
Child's Name*
First Last
Hebrew Name
Birth Date*
Registering for...*
- Preschool (Sunday) 9:30 - 11:30am
- Judaica (Sunday) K-7th grade, 10:00am - 12:15pm
- Hebrew School (Wednesday) 3rd-6th grade, 6:30pm - 8:00pm
- Bar/Bat Mitzvah (Wednesday) 7th grade
- Confirmation (Sunday) 8th-10th grade
Choose all that apply.
Child's Grade*
Child's School*
Would you like to meet with your child's teacher to discuss needs?
- No
- Yes
Special Services
Have an IEP or 504 plan?*
- No
- Yes
If yes, please describe...
Does your child receive special services at school?*
- No
- Yes
If yes, please describe...
Media Release

You grant permission to Temple Sinai to use your child and family's likeness, image or photos for purposes including but not limited to press releases, publications, website, printed material, and video productions. You release all claim against the Temple with respect to copyright ownership and publication including any claim for compensation related to the use of the materials.
Photo Release Signature*
- Yes. Check here to sign in the affirmative
- No. Check here to sign in the negative
Authorization for Medical Treatment of Minors

If your child needs medical, dental, health, or hospital services...
Known allergies
Medical conditions
List any medicine your child takes regularly
Date of last Tetanus Shot*
Physician's name*
Physician's phone*
Physician's address*
Insurance Company*
Policy ID / Contract number*
Name of Insured*

Second Child Information
Second Child's Name*
First Last
Hebrew Name
Birth Date*
Registering for...*
- Preschool (Sunday) 9:30 - 11:30am
- Judaica (Sunday) K-7th grade, 10:00am - 12:15pm
- Hebrew School (Wednesday) 3rd-6th grade, 6:30pm - 8:00pm
- Bar/Bat Mitzvah (Wednesday) 7th grade
- Confirmation (Sunday) 8th-10th grade
Choose all that apply.
Child's Grade*
Child's School*
Would you like to meet with your child's teacher to discuss needs?
- No
- Yes
Special Services
Have an IEP or 504 plan?*
- No
- Yes
If yes, please describe...
Does your child receive special services at school?*
- No
- Yes
If yes, please describe...
Media Release

You grant permission to Temple Sinai to use your child and family's likeness, image or photos for purposes including but not limited to press releases, publications, website, printed material, and video productions. You release all claim against the Temple with respect to copyright ownership and publication including any claim for compensation related to the use of the materials.
Signature*
- Yes. Check here to sign in the affirmative
- No. Check here to sign in the negative
Authorization for Medical Treatment of Minors

If your child needs medical, dental, health, or hospital services...
Known allergies
Medical conditions
List any medicine your child takes regularly
Date of last Tetanus Shot*
Same physician as first child?*
- Yes
- No
Please list physician's name, phone number and address.
Same insurance as first child?*
- Yes
- No
Please list insurance company, policy ID / contract number, and name of insured.

Third Child Information
Third Child's Name*
First Last
Hebrew Name
Birth Date*
Registering for...*
- Preschool (Sunday) 9:30 - 11:30am
- Judaica (Sunday) K-7th grade, 10:00am - 12:15pm
- Hebrew School (Wednesday) 3rd-6th grade, 6:30pm - 8:00pm
- Bar/Bat Mitzvah (Wednesday) 7th grade
- Confirmation (Sunday) 8th-10th grade
Choose all that apply.
Child's Grade*
Child's School*
Would you like to meet with your child's teacher to discuss needs?
- No
- Yes
Special Services
Have an IEP or 504 plan?*
- No
- Yes
If yes, please describe...
Does your child receive special services at school?*
- No
- Yes
If yes, please describe...
Media Release

You grant permission to Temple Sinai to use your child and family's likeness, image or photos for purposes including but not limited to press releases, publications, website, printed material, and video productions. You release all claim against the Temple with respect to copyright ownership and publication including any claim for compensation related to the use of the materials.
Signature*
- Yes. Check here to sign in the affirmative
- No. Check here to sign in the negative
Authorization for Medical Treatment of Minors

If your child needs medical, dental, health, or hospital services...
Known allergies
Medical conditions
List any medicine your child takes regularly
Date of last Tetanus Shot*
Same physician as first child?*
- Yes
- No
Please list physician's name, phone number and address.
Same insurance as first child?*
- Yes
- No
Please list insurance company, policy ID / contract number, and name of insured.

Fourth Child Information
Fourth Child's Name*
First Last
Hebrew Name
Birth Date*
Registering for...*
- Monthly Sunday Preschool 10:00 - 11:45am
- Sunday Judaica (K-7th grade) 10:00am - 12:15pm
- Wednesday Hebrew (3rd-6th grade) 6:00pm - 7:30pm
- B’nai Mitzvah Wed Hebrew (7th grade)
- Sunday Confirmation (8th-10th grade)
Choose all that apply.
Child's Grade*
Child's School*
Would you like to meet with your child's teacher to discuss needs?
- No
- Yes
Special Services
Have an IEP or 504 plan?*
- No
- Yes
If yes, please describe...
Does your child receive special services at school?*
- No
- Yes
If yes, please describe...
Media Release

You grant permission to Temple Sinai to use your child and family's likeness, image or photos for purposes including but not limited to press releases, publications, website, printed material, and video productions. You release all claim against the Temple with respect to copyright ownership and publication including any claim for compensation related to the use of the materials.
Signature*
- Yes. Check here to sign in the affirmative
- No. Check here to sign in the negative
Authorization for Medical Treatment of Minors

If your child needs medical, dental, health, or hospital services...
Known allergies
Medical conditions
List any medicine your child takes regularly
Date of last Tetanus Shot*
Same physician as first child?*
- Yes
- No
Please list physician's name, phone number and address.
Same insurance as first child?*
- Yes
- No
Please list insurance company, policy ID / contract number, and name of insured.
Consent
By submitting this form, you (being the parent of custody or legal guardian of the above named minor) do hereby appoint Temple Sinai Religious School, 509 Broadway, Saratoga Springs, New York 12866 to act on your behalf in authorizing unexpected medical, dental or surgical care, or hospitalization for the above named minor(s) in your absence.

This form is valid for a period of one year from the date signed.

Dated: 07/17/2019
Signature*
- Check this box to sign in the affirmative

EMERGENCY CONTACT
Name*
First Last
Home Phone
Cell Phone
Relationship to student*

Community Volunteer Information
Your support and assistance are essential to the running of our school. Please mark any of the following areas in which you are willing to help our community. Thank you!
Choose all that apply
- Classroom Volunteer (Sunday)
- Classroom Volunteer (Wednesdays)
- Chaperone for field trips & youth group events
- Set-up / Clean-up for special school events
- Substitute Teacher (Sundays)
- Substitute Teacher (Wednesdays)
- Sharing my skills and interests
- Parent Committee (help plan & organize events & programs for our school community)
What grade levels?
What skills or interests?

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Today

Times for Jul 17, 2019
14 Tamuz, 5779
י״ד בְּתַמּוּז תשע״ט
Sunrise: 5:30 AM
Sunset: 8:31 PM

This Friday

Shabbos Times for Jul 19, 2019
16 Tamuz, 5779
ט״ז בְּתַמּוּז תשע״ט
Parashat Balak / פרשת בלק
Sunset Friday: 12:00 AM
Sunrise: 12:00 AM
Sunset Saturday: 8:29 PM

Navigation

About
Learning
- Religious School
- Adult Programs
Temple Sinai Library
- About the Library
- Library Book List
Meet the Rabbis
Contact
News
- All
- Adult Ed
- Art
- Celebration
- Community
- Kids
- Rabbis
- Storytelling
- Travel
Support Temple Sinai
Join

News

Categories
- Adult Ed
- Art
- Celebration
- Community
- Kids
- Rabbis
- Storytelling
- Travel

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