PAYQUIQ ONLINE :: The Faster Smarter Way to Pay

Family Information

Parent #1 Contact Information

* Parent #1 Name

* Home Phone

* Parent #1 Cell Phone

Parent #2 Contact Information

Parent #2 Name

Home Phone

(If Different)

Parent #2 Cell Phone

Family Address

* Street Address

* City, State, Zip

* Email address to receive school correspondence

Additional email(s) to receive school correspondence

* Child(ren)'s Physician Name and Phone Number

* Child(ren)'s Dentist/Orthodontist Name and Phone Number

Please provide us with an EMERGENCY CONTACT to be notified if both parents are unreachable.

* Name, Relationship & phone number

* I empower Temple Shaaray Tefila and its agents to act for me in accordance with their best judgement in case of an emergency. It is my understanding that all accidental health care and medical attention while my child is at school will be billed to me.

	yes, I authorize
	no, I do not authorize

* I furthermore give permission for photographs, slides, videos, or audiotapes of my child(ren) to be used for our website, public relations purposes, and promotion of Temple Shaaray Tefila and our school.

yes, I authorize
no, I do not authorize

Child 1

* Child 1 Name

Child 1 email address if known

* Please provide the name of private or public school for 2021-2022 school year

1st Grade -12th Grade Classes

Child 1 - 1st choice for class day/time

Participation in the B'nai Mitzvah Retreat is a requirement for all 6th graders. We will notify all 6th grade parents of the date as it approaches. You will be sent an invitation after the start of the school year with more information. If COVID-19 safety protcols allow, 10th grade includes a mandatory 4 day/3 night trip to RAC (Religious Action Center) in Washington, D.C. The cost has been removed from this form until we have more information.

Check here if your child would like to participate in Junior Choir which will take place during Religious School hours (for 1st to 7th graders) if COVID-19 safety protocols allow group in-person choirs.

	Sunday-during Religious School hours
	Monday-during Religious School hours

It is our goal to provide a warm, creative, and nurturing learning environment for each of our students. In order to provide the best education, we need to know as much as possible about your child. The more information you share, the better able we are to meet the needs of your student. Information will be shared with your child's classroom teacher unless you indicate otherwise.

Does this student have any special learning needs of behavioral issues/concerns? If so, please describe and note any successful strategies utilized in other school settings.

Is there any documentation (IEP, 504, etc) that can be shared? If so, please send to the Religious School Director

	Yes
	No

What is your child's learning style?

	Visual
	Auditory
	Tactile
	Kinesthetic

Please list any food/medication allergies

Please list any medications your child is currently taking

Child 2

Child 2 Name

Child 2 email address if known

Please provide the name of the public or private school for the 2021-2022 school year

1st Grade -12th Grade Classes

Child 2 - 1st choice for class day/time

	Every Sunday-during Religious School hours
	Every Monday-during Religous School hours

Does this student have any special learning needs of behavioral issues/concerns? If so, please describe and note any successful strategies utilized in other school settings.

Is there any documentation (IEP, 504, etc) that can be shared? If so, please send to the Religious School, attn: Stephanie Ben Simon

	Yes
	No

What is your child's learning style?

	Visual
	Auditory
	Tactile
	Kinesthetic

Please list any food/medication allergies

Please list any medications your child is currently taking

Child 3

Child 3 Name

Child 3 email address if known

Please provide the name of the public or private school or the 2021-2022 school year

1st -12th Grade Classes

Child 3 - 1st choice for class day/time

	Every Sunday-during Religious School hours
	Every Monday-during Religious School hours

Does this student have any special learning needs of behavioral issues/concerns? If so, please describe and note any successful strategies utilized in other school settings.

Is there any documentation (IEP, 504, etc) that can be shared? If so, please send to the Religious School Director

	Yes
	No

What is your child's learning style?

	Visual
	Auditory
	Tactile
	Kinesthetic

Please list any food/medication allergies

Please list any medications your child is currently taking

Please carefully select one of the payment options below:

Payment Options

* I am paying in full today

Registration forms will only be accepted and processed if your family is a member in good standing of the Temple for 2020-2021.
The Temple commits to teachers, arranges class sizes, and purchases supplies based on the number of registrations. Therefore, Religious school tuition is non-refundable after August 1st.
Our congregation believes that becoming B'nai Mitzvah is part, but not the end, of a child's Jewish education. Enrollment, payment, and participation in the 7th grade program for the full year are required for students. If you have any questions, please contact the Director of Education, Stephanie Ben Simon, [email protected] .
Our on-line payment system offers the option of paying by check by using the drop down menu in the payment information section.
If you choose to pay by credit card, there will be a 2.5% convenience fee added.
If you are unsure about your membership status, or wish to discuss a special arrangement, please contact Mona Halter at [email protected].