Religious School/T3 Registration - Form

Registration 2025-2026
Welcome to our new online school registration form. This form allows you to register BY FAMILY. Please complete all fields for each child you enroll in our programs. Contact Rachael Rovner, Rachael@bsholom.org with any questions about our programs or this form. We do not want finances to be a barrier to enrollment. If you need tuition assistance, please contact Rachael.

FAMILY INFORMATION

* Parent/Guardian #1 First Name

* Parent/Guardian #1 Last Name

* Relationship to Student(s)

* Parent/Guardian Cell Phone

Work Phone

* Email

Parent/Guardian #2 First Name

Parent/Guardian #2 Last Name

Cell Phone

Relationship to Student

* Primary Home Address for Student(s)

* City, State, Zip

Home Phone (if applicable)

* Please send all school-related communication to

P/G 1 onlyP/G 2 onlyBoth P/G 1 & 2

* May we take & use your child(ren)'s photo and use it for promotional materials, school newletter, or other internal use? This could include social media (without names listed).

YES, for any useNO, not for any use

* Emergency Contact Information - Required

Please provide the name and number of a local friend or family member (NOT a parent/guardian) who can be contacted in the case of emergency (if both parents are unreachable).

* Authorized Alternate Pick-Up Person - Required

Please provide the name and number of someone who is not a parent/guardian and may pick up your children.

STUDENT INFORMATION

* Student #1 First Name

* Student #1 Last Name

* Student #1 Pronouns

* Date of Birth (mm-dd-yyyy)

* This Student is Enrolling In:

Ein-STEAM (K-5 Wed 4:30-5:45)Differentiated Hebrew Language Learning (K-5 Wed 5:45-6:30)Weekly Community Dinner (included with T3 - Wed 6:15-6:45)T3 - Hands on Jewish Learning and Peer - Led Bible Reflection (Wed 6:45-8:00)

* Grade (2025-26)

* Name of School

Hebrew Name

* Child's Primary Physician

Name and phone number

* Please list ALL allergies and medical conditions

If none, please type NONE

Please list all medications your child takes regularly, presciption and otherwise.

If none, please type NONE.
If your child has a medication related to a potentially life-threatening condition (eg. Epi-Pen), we will ask you to keep a dose of it here on site.

Please share with us any information about your child, including learning differences, that may assist our teachers and give us greater context about what helps your child thrive in an educational environment.

Does your child have an IEP/504 Plan?

If yes, we invite you to share this with our Director of Education, as well as any other pertinent information.

If you are not enrolling another child, please go to the Medical Release & Liability.

Student #2 First Name

Student #2 Last Name

Student # 2 Pronouns

Date of Birth (mm-dd-yyyy)

This Student is Enrolling In:

Ein-STEAMDifferentiated Hebrew Language LearningCommunity Dinner (Included in T3)T3 - Hands on Jewish Learning + Peer Bible Reflection

Grade (2025-26)

Name of School

Student #2 Hebrew Name

Child's Primary Physician

Name and Phone Number

Please list ALL allergies and medical conditions

If none, please type NONE

Please list all medications your child takes regularly, presciption and otherwise.

If none, please type NONE.
If your child has a medication related to a potentially life-threatening condition (eg. Epi-Pen), we will ask you to keep a dose of it here on site.

Does your child have an IEP/504?

If yes, we invite you to share this with our Director of Education, as well as any other pertinent information.

If you are not enrolling another child, please go to the Medical Release & Liability.

Student #3 First Name

Student #3 Last name

Student # 3 Pronouns

Date of Birth (mm-dd-yyyy)

mm/dd/yy

This Student is Enrolling In:

Ein-STEAMDifferentiated Hebrew Language LearningCommunity Dinner (Included in T3)T3 Hands on Jewish Learning and Peer Led Bible Reflections

Grade (2025-26)

Name of School

Hebrew Name

Child's Primary Physician

Name and Phone Number

Please list ALL allergies and medical conditions

If none, please type NONE

Please list all medications your child takes regularly, presciption and otherwise.

If none, please type NONE.
If your child has a medication related to a potentially life-threatening condition (eg. Epi-Pen), we will ask you to keep a dose of it here on site.

Does your child have an IEP/504?

If yes, we invite you to share this with our Director of Education, as well as any other pertinent information.

Medical Release & Liability
If my child is ill or injured at school, needs emergency care, and I cannot be contacted, I hereby authorize Beth Sholom Synagogue (“BSS”) to make all necessary arrangements. I agree to assume all responsibility and expenses, including transportation, incurred at that time. Emergency care will be provided as directed by emergency personnel responding to BSS.

By entering my initials below and by enrolling my child(ren) in Religious School at Beth Sholom Synagogue, I agree with and consent to the above terms and conditions.

* Yes, I have read and consent to the above terms and conditions.

Please type your initials in the space provided.

Community Covenant

Our school community is rooted in mutual respect for learning and growth. In the spirit of kehillah kedosha (holy community) to achieve our goals and ensure the integrity of our program, the following is the covenant to which the student, parent, and Synagogue agree:

Standards of Behavior:

Ein-STEAM and T3 students agree to:
1. Honor the right of all students to learn and behave in ways that make that possible.
2. Act with respect towards all people and respect the sanctity of the building.
3. HAVE FUN!!!!
The School, Teachers and Parents agree to:
1. Participate as partners in the Jewish development of the student.
2. Actively listen and respond to issues.
3. Communicate schedule changes, absences, and delays in a timely manner.
4. Assist any student who needs extra help to the best of our abilities and resources.
5. Create an atmosphere of warmth and inclusivity, as each community member is b'tzelem elohim, created in the Divine Image.
6. Share important information about students, especially as it pertains to behavior, health, and significant life changes. This will always be shared with discretion and intention.

* Yes, we have read and consent to the Community Covenant

Yes, we have read and consent to the Community CovenantCommunity Covenant

TUITION

	BSS Member	Associate Member	Non-Member
Ein-STEAM, K – 5	$900	$950	$1,000
(Wed - 4:30-5:45)	$900	$950	$1,000
Differentiated Hebrew Language	Included	$50	$200
(Wed - 5:45-6:30)	Included	$50	$200
T3 + Dinner 6-12	$550	$625	$750
(Wed 6:15-8:00)	$550	$625	$750
Community Dinner	$200 k-5 ONLY	$200	$250
Parent Association Fee (per child) Programming fee (per family)	Included	Included	Included
Teacher Recognition (per child)	Included	Included	Included
Security Fee (per child)	Included	Included	Included

K - 6 (Member)

K - 6 (Associate)

K - 6 (Non-member)

Hebrew Language (Non member)

Hebrew Language (Associate)

Dinner (k-5 + Non-member)

Teen Talmud Torah (Member)

Teen Talmud Torah (Associate)

Teen Talmud Torah (Non-member)

Dinner (k-5 and Associate)

Total