TBO Religious School Registration 2019-2020
Please complete the following information about your child.
Sign in to Google to save your progress. Learn more
Email *
Child's Name (first and last name) *
Birthdate *
MM
/
DD
/
YYYY
Parent/Guardian 1 Name *
Parent/Guardian 2 Name
Email - Parent/Guardian 1 *
Email - Parent/Guardian 2
Phone - Parent/Guardian 1 *
Phone - Parent/Guardian 2
Address
I would like my child placed with a friend (ONE name only)
What grade will your child be entering in September 2019? *
Grades 3, 4 or 5 please select both your first and second preferences for Hebrew language tutoring: Small Group (average 5-6 students per group) OR Skype (Individual, scheduled with tutor).  Efforts will be made to accommodate  your first choice. Choices will be on a first come first serve basis. (For Skype, please select for both choice 1 & 2) *
Th 4:30-5:30
Th 5:00 - 6:00
Skype
N/A
CHOICE 1
CHOICE 2
Grades 6 please choose option:
Clear selection
Does your child have special medical or learning needs?
If yes, please provide details below.
Does your child have food allergies?
If yes, please provide details below.
Name of Health Insurance Carrier *
Health Insurance Policy Number *
Photo Release *
I grant permission to use any photographs and/or videos of my child taken at school for publicity and marketing purposes, both in print and online. I agree that neither I, nor my child will receive compensation for the use of any images.
Emergency Medical Release *
I hereby give my consent for Temple B'nai Or to make available to my child professional emergency medical care if such care is indicated. It is my understanding that a conscientious effort will be made to contact me before such action is taken. It is further understood that every effort will be made to contact my child's physician prior to any treatment. However, in the event that this is not possible, I give my permission for my child to receive proper medical care by any doctor, nurse, paramedic or member of a medical staff of a hospital licensed in the State of New Jersey.
Emergency Contact Name *
(Other than parents)
Emergency Contact Phone Number *
Submit
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy
Google Forms