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Form Gesher/Nitzanim 2024-2025 Registration
Please verify reCaptcha before submitting the form.
This form is to register for Temple Israel's Religious School Gesher or Nitzanim programs for the 2024-2025 school year.
Please fill out all information fields below. More fields will become available once the original fields are completed.
Once your enrollment is received, it must be approved by the School staff. You will receive an email when this has been completed.
*
Parent/Guardian 1 - First Name
*
Parent/Guardian 1 - Last Name
*
Parent/Guardian 1 - Email
*
Parent/Guardian 1 - Mobile Phone
*
Parent/Guardian 1 - Address
*
Parent/Guardian 1 - City
*
Parent/Guardian 1 - State
--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
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Parent/Guardian 1 - Zip Code
Parent/Guardian 1 - Home Phone
*
Is there a second parent/guardian?
Please Select One
Yes
No
*
Parent/Guardian 2 - First Name
*
Parent/Guardian 2 - Last Name
*
Parent/Guardian 2 - Email
*
Parent/Guardian 2 - Mobile Phone
*
Does the second parent/guardian live at the same address as parent/guardian 1?
Please Select One
Yes
No
*
Parent/Guardian 2 - Address
*
Parent/Guardian 2 - City
*
Parent/Guardian 2 - State
--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
*
Parent/Guardian 2 - Zip Code
Parent/Guardian 2 - Home Phone
*
How many students are you registering for 2024-2025 school year ($725 per child)?
Please Select One
One student
Two students
Please indicate if your child is registering for Gesher or Nitzanim
Gesher (Pre K - 4 year olds)
Nitzanim (Kindegarten - 5 year olds)
Student 1 - First Name
Student 1 - Last Name
Student 1 - Gender
Student 1 - Hebrew Name
Student 1 - Birthdate
Student 1 - Grade as of September 2024
Student 1 - IEP
Does he/she have an IEP or special arrangements in Public School?
Student 1 - Allergies
Does this child have any allergies, medications, or food restrictions we should be aware of?
Total Amount
Student 2 - First Name
Student 2 - Last Name
Student 2 - Gender
Student 2 - Hebrew Name
Student 2 - Birthdate
Student 2 - Grade as of September 2024
Student 2 - IEP
Does he/she have an IEP or special arrangements in Public School?
Student 2 - Allergies
Does this child have any allergies, medications, or food restrictions we should be aware of?
PHOTO WAIVER
*
Photo Waiver
Please Select One
Yes
No
I give Temple Israel permission to use photos of my child(ren) in its publicity such as in the synagogue bulletin, website, social media, and local newspapers, etc..
EMERGENCY CONTACT INFORMATION
Emergency Contact 1 - Name
In the event that we cannot contact you, what is the name of your family's emergency contact?
Emergency Contact 1 - Primary Phone
What is the first phone number we should try for this person if we cannot contact you?
Emergency Contact 1 - Alternate Phone
What is the alternate phone number, if any, for this contact?
Would you like to donate to our Parent Association?
Tuition alone only covers part of the costs of operating our Religious School. Support provided by the Religious School Parent's Association underwrites the costs of equipment, programs, and "special touches" for things which the budget doesn't allow us to address. Your PA dues truly enhance the quality and richness of our wonderful school! Thank you so much.
Sat, September 7 2024 4 Elul 5784