2018-19 RELIGIOUS SCHOOL REGISTRATION

Temple Micah Religious School

Student Registration and Emergency Form

2018-2019/ 5779

Family Information

Parent/Legal Guardian Name

Phone (1)

Phone (2)

Parent/Legal Guardian Name

Phone (1)

Phone (2)

Parent Email(s) for Religious School Communication

Home Address(es)

Additional Parent/Guardian Information

Are you a member of Temple Micah?

Emergency Information

In case of MILD INJURY, may we administer first aid?

In case of SERIOUS ILLNESS/INJURY, if parents cannot be contacted, may we call 911 if necessary?

If answer to this question is no, please tell us what you want done.

Please list two local emergency contacts in the event that parent/guardian cannot be reached.

Name:

Relationship:

Phone:

Name:

Relationship:

Phone:

In case of a medical emergency, I authorize the staff of TMRS to obtain emergency medical treatment for my child as detailed above.

Please type your name as parent or guardian here to indicate your signature and consent:

Date:

Student Information

1. Name of Student (English)

and (Hebrew)

Date of Birth:

Gender:

School Grade Fall 2018:

Known food or drug allergies or specific diet:

Daily medications, if any:

Learning difficulties that we should know about, if any:

Anything else we should know?

2. Name of Student (English)

and (Hebrew)

Date of Birth:

Gender:

School Grade Fall 2018:

Known food or drug allergies or specific diet:

Daily medications, if any:

Learning difficulties that we should know about, if any:

Anything else we should know?

3. Name of Student (English)

and (Hebrew)

Date of Birth:

Gender:

School Grade Fall 2018:

Known food or drug allergies or specific diet:

Daily medications, if any:

Learning difficulties that we should know about, if any:

Anything else we should know?

PLEASE CONTACT TEMPLE MICAH IF YOU HAVE MORE THAN 3 CHILDREN TO ENROLL

Please complete ALL information NO LATER THAN September 4, 2018

You can contact us at:

Temple Micah Religious School

5209 Montview Blvd. Denver, CO 80207

amy.krivel@micahdenver.org

We need registration and tuition forms to be able to plan on amount of staff and classroom space, so please fill this out as soon as you can to help us plan a wonderful year for your children.

TEMPLE MICAH RELIGIOUS SCHOOL

TUITION PAYMENT CONTRACT

Brit/Contract between Temple Micah and Religious School Families

TUITION:

Member in good standing of Temple Micah

$575.00 for one child ($550.00 second child; $525.00 each additional child)

Non - member

$900.00 for one child ($850.00 second child; $820.00 each additional child)

PAYMENT OPTIONS AND SCHEDULE:

(Please choose one)

Due Dates if choosing Payment Plan:

1st payment on or before September 4th, 2018

2nd payment on or before October 2nd, 2018

Final payment on or before November 6th, 2018

a. Child's name

Tuition

b. Child's name

Tuition

c. Child's name

Tuition

* CALCULATE TOTAL TUITION and ENTER HERE:

If choosing monthly payments, you will have the option on the next screen to divide your total into 3 payments. Choose from the drop down menu just below 'Total Tuition'.

This is a brit/contract with Temple Micah and I commit to full payment of religious school tuition by November 6, 2018. I realize that if I am not able to complete this payment on time, I will seek assistance from the temple staff prior to that date, otherwise my child(ren) may not be able to return until such payment is resolved.

Please type your name here to indicate your signature and consent:

Date:

SHABBAT SUPPER CLUBS

This year, all families will get to participate in Shabbat supper Clubs. You will have the choice to host or be hosted by other Micah families with similar aged children throughout the year. If you have a preference to host or to be hosted, please specify below.

Please choose one:

PHOTO OF EACH CHILD

Please email a recent color photo of each child you are enrolling, as well as a family photo. Please indicate the first and last name of the child in each photo. This will help us all better get to know everyone at religious school! Please email photos to amy.krivel@micahdenver.org

RELEASE OF PHOTOGRAPHS FOR MINORS

I, parent or guardian, hereby grant permission to Temple Micah to take and use: photographs and/or digital images of my child for use in news releases, promotional materials, Micah Facebook Page, internal emails, and other electronic communications. I further agree that my child's name and identity may be revealed in descriptive text or commentary in connection with the image(s).

List child's name(s)

Please choose one:

Please type your name here to indicate parent or guardian signature:

Thank you for registering for Temple Micah Religious School! Please continue to the next page to make your payment. Contact Temple Micah if you have any questions or need assistance.

Date:

Fri, April 26 2024 18 Nisan 5784