Registration


Mother's Information

Father's Information

Same as Mother's Address

Emergency Contacts
1. 


2. 



Parents, please chose one of the following to enhance your child’s Religious School experience.
  1.  Holiday Programming
  2.  Fundraising for summer Jewish experiences including Jewish Camps, Study in Israel
  3.  Social events for kids and parents

Are you interested in being one of our fabulous teachers?


1. Hebrew School:
If Yes enter name(s) below
2. Religious School:
If Yes enter name(s) below

Permissions

I hereby grant and assign Temple Emanu-El the irrevocable and unrestricted right to use and publish for editorial trade, advertising or any other purpose and in any manner and medium including website and internet promotion, all photographic, video, and digital images:



I affirm that I understand the instructions as listed on this form and that all information I have provided is valid and complete.



Payment

Your banking and credit card information is kept secure using SSL 256-bit encryption.

Kindergarten-3rd  Member $458.00   Non-Member $505.00 
4th-6th  Member $683.00  Non-Member $750.00 
TEEN’s 7th & 8th  Member $643.00  Non-Member $710.00 
Confirmation 9th & 10th  Member $643.00   Non-Member $710.00 

Automatic Funds Transfer Payments

I authorize Temple Emanu-El to perform an automatic funds transfer on the 1st of each month from my checking account to fulfill my child’s Religious School tuition. If my automatic funds transfer payment fails to process due to insufficient funds or for any other reason, I authorize Temple Emanu-El to collect a $25 fee by electronic charge to my checking account identified below. Please enter your checking account number.



Same as Mother's Address  Same as Father's Address















By check this box you are authorizing Temple Emanu-El to perform an automatic transfer as stated above.



Credit Card Payments

I authorize Temple Emanu-El to charge my credit card on the 1st of each month to fulfill my child’s Religious School tuition. If my credit card payment fails to process due to insufficient funds or for any other reason, I authorize Temple Emanu-El to collect a $25 fee by electronic charge.

Credit Card Type:         


  (Exactly as it appears on card)






Same as Mother's Address  Same as Father's Address










By check this box you are authorizing Temple Emanu-El to charge my credit card as stated above.