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Religious School Registration
Please verify reCaptcha before submitting the form.
The Sy and Susan Sperling School of Jewish Education
Temple Bat Yam
2021-2022 / 5781-5782 Jewish Youth Education Program Registration
Family Information
*
Parent/Guardian 1 First Name
*
Parent/Guardian 1 Last Name
*
Parent/Guardian 1 Address
*
Parent/Guardian 1 City, State, Zip
Parent/Guardian 1 Home Phone
Parent/Guardian 1 Cell Phone
Parent/Guardian 1 Work Phone
Parent/Guardian 1 Email
Parent/Guardian 1 Occupation
*
Parent/Guardian 1 has custody
Yes
No
*
Parent 1 to receive communication
Yes
No
Parent/Guardian 2 First Name
Parent/Guardian 2 Last Name
Parent/Guardian 2 Address
Parent/Guardian 2 City, State, Zip
Parent/Guardian 2 Home Phone
Parent/Guardian 2 Cell Phone
Parent/Guardian 2 Work Phone
Parent/Guardian 2 Email
Parent/Guardian 2 Occupation
Parent/Guardian 2 to has custody
Yes
No
Parent 2 to receive communication
Yes
No
Other Caretaker Information
Caretaker 1 Name
Caretaker 1 Address
Caretaker 1 City, State and Zip
Caretaker 1 Home Phone
Caretaker 1 Cell Phone
Caretaker 1 Work Phone
Caretaker 1 Email
Caretaker 1 Relationship to children
Child lives with Caretaker 1
Yes
No
Caretaker 1 has permission to take children
Yes
No
Caretaker 2 Name
Caretaker 2 Address
Caretaker 2 City, State and Zip
Caretaker 2 Home Phone
Caretaker 2 Cell Phone
Caretaker 2 Work Phone
Caretaker 2 Email
Caretaker 2 Relationship to children
Child lives with Caretaker 2
Yes
No
Caretaker 2 has permission to take children
Yes
No
Other Custodial Information
(We will NOT release your children to anyone other than those listed on this form without written permission. Please provide a copy of a photo for each caretaker listed.)
Medical and Emergency Information
In an emergency, we will call the parents and caretakers listed on this form first.
*
Primary Doctor Name
*
Primary Doctor Phone Number
Health Insurance Company
Group Policy Number
Name of Insured
Policy Number
Enter information below for Student 1
*
Student First Name, Middle
*
Student 1 Last Name
Hebrew name (if known)
** If you do not know your child's Hebrew name or your child was not given a Hebrew name and you would like your child to be named, please call the office (954.928.0410) to make an appointment with Rabbi Spey. He would be happy to discuss this with you.
*
Date of Birth
*
Secular school attending in 2021-2022
*
2021-2022 grade
Which, if any, religious school has your child attended previously? Which grade levels were completed?
Please list any Medical and Food allergies:
Please share with us any way your child may be differently able (physically, emotionally, cognitively, etc.) We want our program to be a positive experience for all our students.
Is there any other information you would like to share about your student or your family that will help us make this a good year and experience at Temple Bat Yam?
Tuition Schedule and Fees
Grade
Day/Time
Tuition & Materials for Members
Tuition & Materials for Non-members
Security
PreK & K
2 Sundays per month, 10 am to 11:30 am
$450
$850
1
st
& 2
nd
Sundays, 9:30 to noon
$775
$1600
3
rd
- 6
th
Sundays, 9:30 to noon,
20-30 min private Hebrew lesson during the week**
$975
$1800
7
th
grade +
Sundays, 9:30 to noon
$775
$1600
Security Fee per Family
$100
Select school fees for Student 1
*
Select school fees for Student 1 (Choose one)
Please Select One
Pre-K - K ($450)
Grade 1- Grade 2 ($775)
Grade 3 - Grade 6 ($975)
Grade 7+ ($775.00)
Pre-K - K ($850) (Non-member)
Grade 1- Grade 2 ($1600) (Non-member)
Grade 3 - Grade 6 ($1800) (Non-Member)
Grade 7+ ($1600) (Non-member)
*
Safety & Security fees
Security Fee ($100)
One Safety & Security Fee required
per family.
Total Display
Enter information below for Student 2
First Name, Middle
Student 2 Last Name
Hebrew name (if known)
** If you do not know your child's Hebrew name or your child was not given a Hebrew name and you would like your child to be named, please call the office (954.928.0410) to make an appointment with Rabbi Spey. He would be happy to discuss this with you.
Date of Birth
Please list any Medical or Food allergies:
Secular school attending in 2021-2022
2021-2022 grade
Which, if any, religious school has your child attended previously? Which grade levels were completed?
Please list any Medical or Food allergies:
Please share with us any ways your child may be differently abled (physically, emotionally, cognitively, etc.). We want our program to be a positive experience for all our students.
Is there any other information you would like to share about your student or your family that will help us make this a good year and experience at Temple Bat Yam?
Select school fees for Student 2
Select school fees for Student 2 (Choose one)
No Student
Pre-K - K ($450)
Grade 1- Grade 2 ($775)
Grade 3 - Grade 6 ($975)
Grade 7+ ($775.00)
Pre-K - K ($850) (Non-member)
Grade 1- Grade 2 ($1600) (Non-member)
Grade 3 - Grade 6 ($1800) (Non-Member)
Grade 7+ ($1600) (Non-member)
Total Display
Enter information below for Student 3
First Name, Middle
Student 3 Last Name
Hebrew name (if known)
** If you do not know your child's Hebrew name or your child was not given a Hebrew name and you would like your child to be named, please call the office (954.928.0410) to make an appointment with Rabbi Spey. He would be happy to discuss this with you.
Date of Birth
Secular school attending in 2021-2022
2021-2022 grade
Which, if any, religious school has your child attended previously? Which grade levels were completed?
Please list any medical or food allergies
Please share with us any way your child may be differently able (physically, emotionally, cognitively, etc.) We want our program to be a positive experience for all our students.
Is there any other information you would like to share about your student or your family that will help us make this a good year and experience at Temple Bat Yam?
Select school fees for Student 3
No Student
Pre-K - K ($450)
Grade 1 - Grade 2 ($775)
Grade 3 - Grade 6 ($975)
Grades 7+ (775)
Pre-K - K ($850) (Non-member)
Grade 1 - Grade 2 ($1600 (Non-member)
Grade 3 - Grade 6 ($1800) (Non-member)
Grades 7+ (1600) (Non-member)
Total Display
Please contact Pam in the main office (954.928.0410) if you would like to apply for financial assistance or if you are not a member of Temple Bat Yam.
** In August, you will receive an invitation to sign up for a regular day and time for your child(ren)'s lessons.
*
Signature of Parent or Guardian
*
Date
*
Relationship to Child
Wed, May 31 2023 11 Sivan 5783
