Religious School Registration - Temple Beth Tikvah Bend

Jewish Community Religious Education Registration 2021 - 2022

Please complete all sections of this application:

FAMILY INFORMATION:
Parent/Guardian Name (1)*

(Full Name of Parent/Guardian 1)
Mailing Address (1)*
Street Address Address Line 2 City State ZIP Code
Parent/Guardian Email (1)*
Parent/Guardian Cell Phone # (1)
Do you have a home phone to include?*
- Yes
- No
Parent/Guardian Home Phone #
(Home phone number of Parent/Guardian 1, if you have one)
Is there another Parent/Guardian to be listed?*
- Yes
- No
Does this Parent/Guardian live at the Address above?*
- Yes
- No
Parent/Guardian Name (2)*

(Full Name of Parent/Guardian 2)
Parent/Guardian Address (2)*
Street Address Address Line 2 City State ZIP Code
Parent/Guardian Email (2)
Parent/Guardian Cell Phone # (2)
Children's Address*
Street Address Address Line 2 City State ZIP Code
Congregation Affiliation:
The term affiliation means you have a registered membership and are current in your financial obligation with either Temple Beth Tikvah, Congregation Shalom Bayit or Chabad. Please note, the Religious School Governance Committee confirms affiliation upon receiving school registration forms. If you wish to receive the affiliation discount, please make sure you are affiliated prior to turning in your school forms.
Which congregation are you affiliated with?*
- Temple Beth Tikvah
- Chabad of Central Oregon
- Shalom Bayit
- Not affiliated with any of these congregations
How many children are you registering for Religious and/or Hebrew School?*
- 1
- 2
- 3
Name of Child 1*

(Full Name of Child 1)
Birthdate for Child 1*
Month
Day
Year
Grade (in Sept) for Child 1*
Registration for Child 1*
- Religious School
- Hebrew School
(Select Religious School and/or Hebrew School)
Hebrew Name of Child 1

(If you know it, the Hebrew Name of Child 1, spelled out in English)
Name of Child 2*

(Full Name of Child 2)
Birthdate for Child 2*
Month
Day
Year
Grade (in Sept) for Child 2*
Registration for Child 2*
- Religious School
- Hebrew School
(Select Religious School and/or Hebrew School)
Hebrew Name of Child 2

(If you know it, the Hebrew Name of Child 2, spelled out in English)
Name of Child 3*

(Full Name of Child 3)
Birthdate for Child 3*
Month
Day
Year
Grade (in Sept) for Child 3*
Registration for Child 3*
- Religious School
- Hebrew School
(Religious School and/or Hebrew School)
Hebrew Name of Child 3

(If you know it, the Hebrew Name of Child 3, spelled out in English)
NOTE: If you have more than 3 children to register, please submit those extra names, birthdates, grades, and Religious/Hebrew school selections via email to the TBT Treasurer at TBTtreasurer@gmail.com.
RELIGIOUS PROGRAM OFFERINGS AND FEES: Our fees include books and materials.
It is our goal to make Religious School available to every family that wishes to participate.

[NOTE: Scholarships are available for those in need of financial assistance. To discuss financial arrangements, TBT members please contact Rabbi Hershenson at johannahershenson@gmail.com or the TBT Treasurer, Mark Schindel, at TBTtreasurer@gmail.com. Shalom Bayit members, please contact your rabbi or treasurer. All financial information is kept strictly confidential.]
Religious School -- meets twice a month for grades K - 7. If affiliated with a Central Oregon Synagogue the fee for first child is $260 and each additional child is $235. If not affiliated with a Central Oregon Synagogue the fee for first child is $520 and each additional child is $470.

Hebrew School -- meets weekly for grades 3 and up. Fee is $250 per child.
Child 1 - Religious School
Price:
Child 1 - Religious School Non Affiliated
Price:
Child 1 - Hebrew School
Price:
Child 2 - Religious School
Price:
Child 2 - Religious School
Price:
Child 2 - Religious School Non Affiliated
Price:
Child 2 - Religious School Non Affiliated
Price:
Child 2 - Hebrew School
Price:
Child 3 - Religious School
Price:
Child 3 - Religious School Non Affiliated
Price:
Child 3 - Hebrew School
Price:
YOUR TOTAL SCHOOL TUITION FEES: $
$0.00
Planned Payment Method: If paying by check: Temple Beth Tikvah, Chabad and non-affiliated families please make your checks payable to Temple Beth Tikvah; TBT, Chabad and non-affiliated families may also pay by credit card on the "Thank You" page. Congregation Shalom Bayit families please make your check or credit card payments payable to JCCO.
Payment method:*
- Check (preferred)
- Credit Card
- Payment will be made to JCCO
HEALTH INFORMATION & EMERGENCY CONTACT: Please complete the following:
Do all of the enrolled children have the same doctor?*
- Yes
- No
Doctor's Name*
Doctor's Phone #*
Doctor's Name - child 2
Doctor's Phone - child 2
Doctor's Name - child 3
Doctor's Phone - child 3
In case of an emergency, parents will be contacted first. If parents cannot be reached, the emergency contact will be called.
Emergency Contact Name
Emergency Contact Phone
Emergency Contact Relationship
Do any of your children have allergies, medical issues or food restrictions?*
- Yes
- No
Please list each child's name and an explanation of any health issues in the box below.
Health Issues
Is there anything you want your child's teacher to know about them or their learning style?*
- Yes
- No
Please list each child's name and an explanation of any learning issues in the box below.
Learning Style
After completing your Religious School Registration and CAPTCHA prompt, click the "Submit" button and wait for the Thank You confirmation message; this may take a few seconds. Your completed Registration is transmitted to our TBT Treasurer for further processing.

You will receive a confirmation email, with information on making your payment. If you should have any problems, please contact us at: templebethtikvah@gmail.com
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