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2022/23 Shorashim RS Registration

Section A: Family Contact Information

If there is a secondary contact, all emails and mailings will go to both contacts. In case of urgent need, the primary contact will be notified first

Section B: Student Enrollment Information
Student 1 Information
This is the same as your child's grade for the 2022-2023 secular school year unless you have made other arrangements with the Director of Education.
Information will not be shared publicly. Parents will be copied on all communication to students.
Information will not be shared publicly. Students will not be contacted independently from parents.
If yes, we would love to sit down with you and your child’s teacher before the school year begins so that we are able to discuss the best ways to support your child from the outset.  If you are comfortable we invite you to send any documentation ahead of time to bookkeeper@templebethtorah.net.
Does your child have allergies or medications we need to know about?
Please describe allergies and medications with dosage and timing.
Student 2 Information
This is the same as your child's grade for the 2022-2023 secular school year unless you have made other arrangements with the Director of Education.
Information will not be shared publicly. Parents will be copied on all communication to students.
Information will not be shared publicly. Students will not be contacted independently from parents.
If yes, we would love to sit down with you and your child’s teacher before the school year begins so that we are able to discuss the best ways to support your child from the outset.  If you are comfortable we invite you to send any documentation ahead of time to bookkeeper@templebethtorah.net.
Does your child have allergies or medications we need to know about?
Please describe allergies and medications with dosage and timing.
Student 3 Information
This is the same as your child's grade for the 2022-2023 secular school year unless you have made other arrangements with the Director of Education.
Information will not be shared publicly. Parents will be copied on all communication to students.
Information will not be shared publicly. Students will not be contacted independently from parents.
If yes, we would love to sit down with you and your child’s teacher before the school year begins so that we are able to discuss the best ways to support your child from the outset.  If you are comfortable we invite you to send any documentation ahead of time to bookkeeper@templebethtorah.net.
Does your child have allergies or medications we need to know about?
Please describe allergies and medications with dosage and timing.
Student 4 Information
This is the same as your child's grade for the 2022-2023 secular school year unless you have made other arrangements with the Director of Education.
Information will not be shared publicly. Parents will be copied on all communication to students.
Information will not be shared publicly. Students will not be contacted independently from parents.
If yes, we would love to sit down with you and your child’s teacher before the school year begins so that we are able to discuss the best ways to support your child from the outset.  If you are comfortable we invite you to send any documentation ahead of time to bookkeeper@templebethtorah.net.
Does your child have allergies or medications we need to know about?
Please describe allergies and medications with dosage and timing.
Section C: Release Forms

By signing my name below, I hereby give permission for the minor child(ren) to attend any school activity sponsored by Temple Beth Torah Shorashim/Religious School. I hereby do release and hold harmless Temple Beth Torah and its trustees, agents, officers, servants and employees against loss (including reasonable attorney's fees) from any and all claims, or causes of action of any kind or nature that may be brought by or on behlaf of the said minor child(ren) or by me arising out of any and all known and unknown, foreseen and unforeseen bodily or personal injuries, damages to property and consequences thereof, which may be sustained by the minor or by me, arising out of or in connection with the minor child's participation in this activity, except such liability or claim of liability as may result from gross negligence on the part of Temple Beth Torah. 

If the minor child should suffer an injury or illness during school time, or on any school related trip, I authorize the employees of Temple Beth Torah to use their discretion to transport or to have the minor child(ren) transported to any medical facility and hereby give consent in my absence have the minor child(ren) treated at any medical facility, and I take full responsibility for that action.

By typing my name, I confirm I have read, understand and agree to the above.
Media Release

I hereby give permission to Temple Beth Torah to take and use still photos and video of my child(ren) for appropriate media coverage including the Temple Beth Torah newsletter, website and Facebook page and for the Lorraine and Jack N. Friedman Commission for Jewish Education of the Palm Beaches and other Jewish agencies. NOTE: If you do not sign this form, we will assume agreement to release photos and other information.

By typing my name, I confirm I have read, and understand and agree to the media release stated above and checked next to this signature.
Section D: Congregation Community
Fri, March 29 2024 19 Adar II 5784