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Religious School Registration

Jewish Community Religious Education Registration 2020 - 2021

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
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. Fee for first child is $225 and each additional child is $200.
Hebrew School -- meets weekly for grades 3 and up. Fee is $250 per child.
Child 1 - Religious School
Price:
Child 1 - Hebrew School
Price:
Child 2 - Religious School
Price:
Child 2 - Religious School
Price:
Child 2 - Hebrew School
Price:
Child 3 - Religious School
Price:
Child 3 - Hebrew School
Price:
YOUR TOTAL SCHOOL TUITION FEES: $
$0.00
Planned Payment Method: If paying by check: Temple Beth Tikvah and Chabad families please make your checks payable to Temple Beth Tikvah; TBT members may also pay by credit card on the "Thank You" page. Congregation Shalom Bayit families please make your checks payable to JCCO.
Payment method:*
- Check (preferred)
- Credit Card
Which congregation are you affiliated with?*
- Temple Beth Tikvah
- Chabad of Central Oregon
- Shalom Bayit
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
CAPTCHA

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CONTACT INFO

PO Box 7472
Bend, OR 97708
(541) 388-8826
templebethtikvah@gmail.com

Services are held at:
First Presbyterian Church
230 NE Ninth Street, Bend.

Shabbat Times

Artwork graciously donated by Julie Wohl.
To see more of her work,
visit Julie Wohl Creations.

Yom Rishon, 3 Tammuz 5781