Temple Beth El Religious School New Student and Early Childhood Programs Registration: 2018-2019
THIS IS FOR STUDENTS WHO ARE NEW TO THE SCHOOL AND/OR ENROLLING IN KINDERGARTEN, K'TANIM, OR TEVA KIDS. Returning students in 1st through 7th grades will be registered automatically. To register your new student for the TBE 2018-2019 religious school year, please fill out this form. You will need to fill out the form separately for each child. If you have any questions, please contact Lisa GIttelman-Udi at 203-322-6901 x305 by phone, email eddir@tbe.org. You may also email Beth Silver at education@tbe.org. Thank you!
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Student Last Name *
Student First Name *
Grade *
Student's grade in the 2018-2019 school year:
Required
Gender
If you choose to indicate a gender for your child, please check below.
Clear selection
Student Hebrew Name
Student Date of Birth *
MM
/
DD
/
YYYY
School *
What school will your child attend during the week?
Student Home Address *
Street Name and #, City, State, Zip Code
Home Phone # *
Student Home Phone #
Parent/Guardian # 1 Last Name *
First Name *
Parent/Guardian # 1 First Name
Parent/Guardian # 1 Email
Parent/Guardian # 1 email address
Parent Guardian # 1 Address if different from Student Address
Street Name, #, City, State, Zip Code - if same as student just write "same."
Home Phone #
Parent Guardian Home Phone # if different from Student's Home Phone #
Work #
Parent/Guardian # 1 work phone #
Cell #
Parent/Guardian # 1 cell phone #
Parent/Guardian # 2 Last Name
Parent/Guardian # 2 Last Name
Parent/Guardian # 2 First Name
Parent/Guardian # 2 First Name
Parent Guardian # 2 Address if Different from Student's Address
Street Name, #, City, State, Zip Code - if same as student just write "same."
Home #
Parent/Guardian # 2 home phone # if different from Student's Home Phone #
Work #
Parent/Guardian # 2 work phone #
Cell #
Parent/Guardian # 2 cell phone #
Email
Parent/Guardian # 2 email
I can volunteer!
Please let us know if you are able to volunteer for any of the following. Give us your name and check any or all of the activities listed below:
Medical Information
Please inform us of any medical conditions that may impact your child during school hours. If you need more space to explain, you may choose to email this information to Beth Silver at education@tbe.org. You may also contact Lisa Gittelman Udi directly at 203-322-6901 x305.
Health Insurance
Name of Insurance Company, policy #:
Physician Info
Physician Name # Phone # in case of medical emergency:
Emergency Contact *
In case of an emergency and parent/guardian cannot be reached, please contact: the following - up to 2 names and phone #s:
Special Needs
If your child has any type of special learning need, please explain here: Alternatively, you can choose to email this information to the Education Director at eddir@tbe.org or contact Lisa Gittelman Udi directly at 203-322-6901 x305.
Special Services
If your child receives special services for secular school, (special education classes, resource room put-out, other) please explain here. Alternatively, you can choose to email this information to the Education Director at eddir@tbe.org or contact Lisa directly at 203-322-6901 x305.
Photo Permission *
I give permission for photos of my child to appear on the following: (check all that apply)
Required
Additional Information
Is there anything else you would like us to know about your child? (Subjects he/she particularly likes or dislikes, speical interests, hobbies, areas of strength or challenges, significant changes in school or at home that your child has experienced in the past year, etc.)?
Payment *
YOUR REGISTRATION WILL BE FULLY ACTIVE WHEN WE HAVE RECEIVED A TUITION PAYMENT OR CONFIRMATION THAT YOU HAVE CONTACTED STEVE LANDER TO MAKE ALTERNATIVE PAYMENT ARRANGEMENTS. Please indicate how you will make the payment for your student's registration below.The full tuition fees are as follows: K'tanim and Teva Kids: $100 for TBE members and $150 for non-members K-2nd Grade: First Year TBE Member - $530.00, Returning TBE Member - $980.00, Non-Member - $980 3rd-7th Grade: $1265 (You must be a TBE member to enroll a child in 3rd-7th grade.) Checks should be sent to Temple Beth El 350 Roxbury Rd. Stamford, CT 06902. If you choose to pay by credit card, please contact Linda at 203-322-6901 x302. There will be a 3% fee to cover our credit card fees. To pay online using your checking account, go to this link: http://tinyurl.com/tbepayments2018-2019 If you choose "Alternative Payment Arrangement," please contact Steve Lander at 203-322-6901 x304.
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