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Religious School Registration for School Year 2023-2024

Religious School Registration for School Year 2023-2024:
 
Welcome! We are thankful you’re here, and looking forward to engaging your family in our religious school programming. Please note that our Pre-K class is open to the community, while all other grades (K-12) are for Fairmount Temple members only.

If you have questions about membership or want to learn more about our learning community, please contact Rabbi Elle Muhlbaum at [email protected] or 216-464-1330.

ONLINE REGISTRATION INSTRUCTIONS: Fill out Family information ONCE and then, fill out Student Information for EACH child being registered.

Please contact Elizabeth Kleckner at 216.464.5890 or [email protected] with questions.

Family Information
He / Him / His
She / Her / Hers
They / Them / Theirs
Other
He / Him / His
She / Her / Hers
They / Them / Theirs
Other
Both Parents
Parent 1 Only
Parent 2 Only
Other: Guardian

Email is our primary form of communication.

Trip, Medical and Emergency Authorization

Yes - I authorize Fairmount Temple to give my child(ren) first aid.
No - I do not authorize Fairmount Temple to give my child(ren) first aid.
Yes - I give my permission for my child(ren) to be photographed with the picture to be used for marketing purposes; including the Anshe Chesed Fairmount Temple Facebook Page and Anshe Chesed Fairmount Temple Blog.
No - I do not give my permission for my child(ren) to be photographed with the picture to be used for marketing purposes; including the Anshe Chesed Fairmount Temple Facebook Page and Anshe Chesed Fairmount Temple Blog.
Yes - I give permission for our name, address, phone number and emails to be included and distributed in a roster to encourage Temple friendships.
No - I do not give permission for our name, address, phone number and emails to be included and distributed in a roster to encourage Temple friendships.
Yes - I give permission for my child(ren) to leave Fairmount Temple grounds to participate in Fairmount Temple programs. I understand that my child(ren) may be transported in a staff person's car or the car of another parent.
No - I do not give permission for my child(ren) to leave Fairmount Temple grounds to participate in Fairmount Temple programs. I understand that my child(ren) may be transported in a staff person's car or the car of another parent.
Yes - In case of medical emergency, I authorize Fairmount Temple to arrange for an ambulance/emergency medical treatment for my child(ren). I understand I will contacted as soon as possible.
No - In case of medical emergency, I do not authorize Fairmount Temple to arrange for an ambulance/emergency medical treatment for my child(ren). I understand I will contacted as soon as possible.
Yes - In case of medical emergency, I authorize Fairmount Temple or emergency care provides to contact and obtain relevant information from my child(ren)'s dentist and/or physician.
No - In case of medical emergency, I do not authorize Fairmount Temple or emergency care provides to contact and obtain relevant information from my child(ren)'s dentist and/or physician.
I have read and agree with the above trip, medical and emergency authorization checked above. i agree to release Anshe Chesed Fairmount Temple, its lay leaders and staff from any claim or loss arising out of my child(ren)'s participation in Religious School. I have authority to sign this form on behalf of my family.

Please type your full legal name in agreement with the above Trip, Medical and Emergency Authorizations.

Emergency Contact Information (required fields, please use "NA" if not applicable)

The emergency contact person should NOT be a parent

Student 1
He / Him / His
She / Her / Hers
They / Them / Theirs
Fluid
Other
PreK Program on Sundays
Kindergarten Program on Sundays
First Grade Program on Sundays
Second Grade Program on Sundays
Third Grade Program on Sundays
Fourth Grade Program on Sundays
Fifth Grade Program on Sundays
Sixth Grade Program on Sundays
Seventh Grade Program on Mondays
Seventh Grade Alternative Program Sundays
Eighth Grade Program on Mondays
Eighth Grade Alternative Program Sundays
Ninth Grade Program on Mondays
Ninth Grade Alternative Program Sundays
Tenth Grade Program on Mondays
Tenth Grade Alternative Program Sundays
Eleventh Grade Program on Mondays
Eleventh Grade Alternative Program Sundays
Twelfth Grade Program on Mondays
Twelfth Grade Alternative Program Sundays
ADD/ADHD
Allergies/Asthma
Emotional Disability
Fine Motor Difficulties
Gross Motor Difficulties
Frequent Headaches
Impaired Hearing
Impaired Vision
Learning Disability
Past Serious Illness or Injury
Regular Medication
IEP (please provide a copy for the office to keep on file)
Kindergarten $250.00
Grades 1-12 $555.00
PreK Program $0.00

A payment plan with a non-refundable deposit of $100.00 per child or full payment is due with registration. If full payment is not received, please arrange a monthly or quarterly payment plan in the recurring payment window when prompted at check out. Contact Joey Laidman at [email protected] or 216.464.5890 for special circumstances.

Student 2
He / Him / His
She / Her / Hers
They / Them / Theirs
Fluid
Other
PreK Program on Sundays
Kindergarten Program on Sundays
First Grade Program on Sundays
Second Grade Program on Sundays
Third Grade Program on Sundays
Fourth Grade Program on Sundays
Fifth Grade Program on Sundays
Sixth Grade Program on Sundays
Seventh Grade Program on Mondays
Seventh Grade Alternative Program on Sundays
Eighth Grade Program on Mondays
Eighth Grade Alternative Program on Sundays
Ninth Grade Program on Mondays
Ninth Grade Alternative Program on Sundays
Tenth Grade Program on Mondays
Tenth Grade Alternative Program on Sundays
Eleventh Grade Program on Mondays
Eleventh Grade Alternative Program on Sundays
Twelfth Grade Program on Mondays
Twelfth Grade Alternative Program on Sundays
ADD/ADHD
Allergies/Asthma
Emotional Disability
Fine Motor Difficulties
Gross Motor Difficulties
Frequent Headaches
Impaired Hearing
Impaired Vision
Learning Disability
Past Serious Illness or Injury
Regular Medication
IEP (please provide a copy for the office to keep on file)
Kindergarten $250.00
Grades 1-12 $555.00
PreK Progam $0.00

A payment plan with a non-refundable deposit of $100.00 per child or full payment is due with registration. If full payment is not received, please arrange a monthly or quarterly payment plan in the recurring payment window when prompted at check out. Contact Joey Laidman at [email protected] or 216.464.5890 for special circumstances.

Student 3
He / Him / His
She / Her / Hers
They / Them / Theirs
Fluid
Other
PreK Program on Sundays
Kindergarten Program on Sundays
First Grade Program on Sundays
Second Grade Program on Sundays
Third Grade Program on Sundays
Fourth Grade Program on Sundays
Fifth Grade Program on Sunday
Sixth Grade Program on Sundays
Seventh Grade Program on Mondays
Seventh Grade Alternative Program on Sundays
Eighth Grade Program on Mondays
Eighth Grade Alternative Program on Sundays
Ninth Grade Program on Mondays
Ninth Grade Alternative Program on Sundays
Tenth Grade Program on Mondays
Tenth Grade Alternative Program on Sundays
Eleventh Grade Program on Mondays
Eleventh Grade Alternative Program on Sundays
Twelfth Grade Program on Mondays
Twelfth Grade Alternative Program on Sundays
ADD/ADHD
Allergies/Asthma
Emotional Disability
Fine Motor Difficulties
Gross Motor Difficulties
Frequent Headaches
Impaired Hearing
Impaired Vision
Learning Disability
Past Serious Illness or Injury
Regular Medication
IEP (please provide a copy for the office to keep on file)
Kindergarten $250.00
Grades 1-12 $555.00
PreK Program $0.00

A payment plan with a non-refundable deposit of $100.00 per child or full payment is due with registration. If full payment is not received, please arrange a monthly or quarterly payment plan in the recurring payment window when prompted at check out. Contact Joey Laidman at [email protected] or 216.464.5890 for special circumstances.

If you need to register a 4th Student please contact Elizabeth Kleckner at 216-464-5890

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