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2017-2018 REGISTRATION FORM FOR RIVERDALE TEMPLE SCHOOL
Please scroll below for school times, membership and other important information
Email address
Parent/Guardian #1 First and Last Name
Your answer
Parent/Guardian #1 Email Address
Your answer
Parent/Guardian #2 First and Last Name
Your answer
Parent/Guardian #2 Email Address
Your answer
Parent/Guardian #1 address
Your answer
Parent/Guardian #2 address if different
Your answer
Parent/Guardian #1 cell number
Your answer
Parent/Guardian #2 cell number
Your answer
Is your family a member at Riverdale Temple
Emergency contact name and number other than parent/guardian
Your answer
PHOTO RELEASE FORM : From time to time, RT may use your child’s name, likeness, voice, statements and other information supplied by him/her in a variety of synagogue publications , including but not limited to: Newsletter, Weekly Calendar, Fliers, RT website (both photos and mini videos without individual identification on public facing side of the site, but with names on the password-protected site). This use relates solely to photographs, statements and videotape made during your child’s participation in RT sponsored activities. Please check your preference.
Volunteer: Check off all that apply
Child's Last Name
Your answer
Child's First Name
Your answer
Child's Hebrew Name
Your answer
Child's Birthday (update year)
MM
/
DD
/
YYYY
Child's Grade in school in September 2017
Your answer
Child's School and phone number
Your answer
Child's allergies or medical information
Your answer
Is child interested in participating in Junior Choir on Sunday after school 11:30-12:00 noon?
Does your child have an IEP or 504?
Child # 2
If you are only registering one child please scroll down to "Additional Information"
Child's Last Name
Your answer
Child's First Name
Your answer
Child's Hebrew Name
Your answer
Child's Birthday (update year)
MM
/
DD
/
YYYY
Child's Grade in school in September 2017
Your answer
Child's School and phone number
Your answer
Child's allergies or medical information
Your answer
Is child interested in participating in Junior Choir on Sunday after school 11:30-12:00 noon?
Does your child have an IEP or 504?
Child # 3
If you are only registering one child please scroll down to "Additional Information"
Child's Last Name
Your answer
Child's First Name
Your answer
Child's Hebrew Name
Your answer
Child's Birthday (update year)
MM
/
DD
/
YYYY
Child's Grade in school in September 2017
Your answer
Child's School and phone number
Your answer
Child's allergies or medical information
Your answer
Is child interested in participating in Junior Choir on Sunday after school 11:30-12:00 noon?
Does your child have an IEP or 504?
Please use this space to provide addition information you would like to share about your child/ren , family or hopes for Riverdale Temple, and the upcoming school year. All information is confidential and will not be shared without your approval.
Your answer
ADDITIONAL INFORMATION
To enroll at the Simcha Learning Center you must be Riverdale Temple members. The membership and tuition fees are below:

Kindergarten to third grade:
$500 membership fee, plus a $75 materials fee. The materials fee is per child. This includes free Religious School tuition.

Fourth grade:
$1000 membership fee per family, plus a $75 materials fee. The materials fee is per child.


Fifth grade:
$1000 membership fee, plus a $700 B'nei Mitzvah fee. The B’nei Mitzvah fee is per child.

Sixth grade:
$1000 membership fee, plus a $700 B'nei Mitzvah fee. The B’nei Mitzvah fee is per child.


Seventh grade:
$2900 membership fee, plus a $700 B’nei Mitzvah fee. The B’nei Mitzvah fee is per child.


Please note: 

1) If you are enrolling more than one child in the Simcha Learning Center, your membership fee corresponds to the grade of your oldest child in attendance.

2) All fees are contingent on your ability to pay. No one will be turned away because of financial difficulties. If you would like to make alternate arrangements (i.e., a further reduced rate and/or payment plan), please reach out to Dorothy Kay or Susan Birnbaum, our financial secretaries, who will work out special, confidential arrangements with you for payment of all fees.


Dorothy Kay 
(347) 602-7842
dottieknits37@gmail.com

Susan Birnbaum 
susansez@gmail.com

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