Religious School Registration 2021-2022

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* Parent 1 First Name

Parent 2 First Name

* Parent 1 Last Name

Parent 2 Last Name

* Parent 1 Address Line 1

Parent 2 Address Line 1

Parent 1 Address Line 2

Parent 2 Address Line 2

* Parent 1 Address City

Parent 2 Address City

* Parent 1 Address State

Parent 2 Address State

* Parent 1 Address ZIP Code

Parent 2 Address ZIP Code

* Parent 1 Email

Parent 2 Email

* Parent 1 Phone Number

Parent 2 Phone Number

* If a parent can’t be reached, please contact these 2 people (Include phone, email, and relationship to student)

* Student 1 First Name

* Student 1 Last Name

* Student 1 Grade Level This Fall

Student 1 Hebrew Name

* Student 1 Birthday

Student 1 Allergies

Student 2 First Name

Student 2 Last Name

Student 2 Grade Level This Fall

Student 2 Hebrew Name

Student 2 Birthday

Student 2 Allergies

Student 3 First Name

Student 3 Last Name

Student 3 Grade Level This Fall

Student 3 Hebrew Name

Student 3 Birthday

Student 3 Allergies

Student 1 Learning Challenges

Student 2 Learning Challenges

Student 3 Learning Challenges

Photo Release Policy

Photo Release PolicyI acknowledge the following Congregation Ner Tamid photo release policy and will contact Cantor Jessica Hutchings at cantor@lvnertamid.org if I want to opt out of this:

It is the practice of Congregation Ner Tamid to use photographs, videos, and quotations of youth involved in synagogue activities in its programs, publications, websites, and the social media of the synagogue for the purpose of promoting the synagogue and its programs. No children will be identified by name in any photograph shared by Congregation Ner Tamid.

* Child 1 Tuition

Child 2 Tuition

Child 3 Tuition

Total

Mon, September 15 2025 22 Elul 5785