Temple Sholom

The Zelda & Herman Schwartz Hebrew School Registration Form

Parent/Guardian Information *

Name of Parent/Guardian 1

Phone number/s *

Parent 1

Email *

Parent 1

Home Address *

Parent/Guardian Information

Name of Parent/Guardian 2

Phone number/s

Parent 2

Student 1 *

First

Last

Hebrew Name

Date of Birth *

Gender

Public School grade as of September 2024 *

Public School school child attends

Student 2

First

Last

Hebrew Name

Date of Birth

Gender

Public School grade as of September 2024

Public School school child attends

Student 3

First

Last

Hebrew Name

Date of Birth

Gender

Public School grade as of September 2024

Public School school child attends

Emergency Contact 1 *

Name and Phone number

Emergency Contact 1

Name and Phone number

Authorized Pick up Information

Those adults who have permission to pick up your child

Medical Information – Please inform us of any allergies, medical conditions, learning needs, or anything you feel we should be aware of so that we may serve your child to the best of our abilities. *

In case of emergency, I authorize the staff of The Zelda & Herman Schwartz Hebrew School to obtain emergency medical treatment for my child. *

Field Trip Consent – I give permission for my child(ren) listed above to participate fully in all activities and/or field trips with the Zelda & Herman Schwartz Hebrew School of Temple Sholom during the 2024-2025 school year. *

Photo/Video Authorization – I give permission for my child(ren) listed above to appear in photographs, videos, and/or the Temple Website to be used by Temple Sholom for publicity, marketing, and/or advertising purposes. No personal information shall be given out identifying a student's name, age, or grade. *

Bus Transportation -For the 2024-2025 School year Bus Transportation is available from PS 236, PS 312, and possibly other schools if the need warrants it. The fee for bus service is $225 for the first child, and $100 for each additional child with a maximum amount of $400 for three or more children. Please Call June Koutros at 718-812-3784 or email her at jek0630@aol.com to find out if your child could receive bus transportation from a school other than those mentioned. *

Bus service is needed for my child(ren)
Bus service is not needed for my child(ren)

TEMPLE MEMBERSHIP – Temple membership includes free Hebrew School tuition and High Holiday tickets for the immediate family. Additional yearly Hebrew School fees include a $60 material and book fee per child, a $75 security fee per family, and a $60 workshop fee per child.

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