Hebrew School Registration

Hebrew School Online Registration Form

Hebrew School Tuition & Synagogue Membership: It is our policy at Temple Adas Israel that every Jewish child will receive a Jewish education and no family is turned away from membership for want of funds. Synagogue membership is strongly encouraged. Please speak to our Membership Chairs: Jackie Kline, Rona Klopman and Steve Rosen about synagogue membership or complete our Temple Adas Israel Family Membership Application.

Bar/Bat Mitzvah students: The Family must be a paid member of Temple Adas Israel for two years preceding the Bar/Bat Mitzvah. Hebrew School tuition must be in good standing for at least the two years preceding the Bar/Bat Mitzvah.

Annual Hebrew School Tuition Fee is $950.00 per student. The online form below must be filled out and submitted prior to making payment. After clicking “submit”, you will be instructed to make payment either online via PayPal, or by mailing a check payable to: “Temple Adas Israel” (memo: Hebrew School Tuition), PO Box 1378, Sag Harbor, NY 11963. For installments, please discuss with Shelley Lichtenstein: 631.353.8395. This form is submitted to Hebrew School Director, Shelley Lichtenstein.

Please complete and submit form then follow instructions to pay tuition.

Student #1

First Name

Last Name

Student #1 Hebrew Name

Student #1 Birth Date

YYYY

Student #1 Secular School

Student #1 Grade

Student #2

First Name

Last Name

Student #2 Hebrew Name

Student #2 Birth Date

YYYY

Student #2 Secular School

Student #2 Grade

Student #3

First Name

Last Name

Student #3 Hebrew Name

Student #3 Birth Date

YYYY

Student #3 Secular School

Student #3 Grade

Parent/Guardian #1

First Name

Last Name

Relationship to Child

Marital Status

Occupation

Home Phone

(###)

###

####

Cell Phone

(###)

###

####

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Parent/Guardian #2

First Name

Last Name

Parent/Guardian #2 Relationship to Child

Parent/Guardian #2 Marital Status

Parent/Guardian #2 Occupation

Parent/Guardian #2 Home Phone

(###)

###

####

Parent/Guardian #2 Cell Phone

(###)

###

####

Parent/Guardian #2 Email

Parent/Guardian #2 Address (if different from above)

Emergency Contact #1

(other than parent) Please indicate name and relationship to child.

Emergency Contact #1 Phone

(###)

###

####

Emergency Contact #2

(other than parent) Please indicate name and relationship to child.

Emergency Contact #2 Phone

(###)

###

####

Person(s) authorized to pick up my child(ren)

Please indicate full names of 2 people, their phone #s and relationships to child(ren).

Medical Information

Please inform us of any allergies or medical condition that may impact your child including an EpiPen and allergy action plan. Please list any medications your child(ren) currently take(s). List each child separately.

Special Services

In order to create the most successful learning experiences for your child(ren), please inform us if your child is currently receiving special services in their secular school. If yes, please specify and keep us updated throughout the year of any changes. If you would like to discuss your child’s needs further, please contact our Hebrew School Director, Shelley Lichtenstein, 631.353.8395

PARENT RELEASE FORM

Photo, Press, Audio and Electronic Media Release.

I hereby give permission to Temple Adas Israel to use photos and videos of my child(ren) for the purpose of Temple Adas Israel or media publications.

I do not give Temple Adas Israel permission to use my child(ren)’s photographs for any publications.

STUDENT INFORMATION

We want to make sure we are teaching your child in a way that best aligns with their learning style. Please tell us a little about your child's interests, strengths, learning needs, and/or anything else you think would be helpful for us to know before the school year starts. Please type Student's name below and answer subsequent questions.

What are your child’s special interests or passions?

What do you feel is the best way to enhance your child’s abilities and learning?

Has your child had any recent trauma, family upset or illness that may have ongoing resonance for him/her? (divorce, death of a grandparent or pet……)

Please list anything else we should know about your child to make his/her learning experience a positive experience.

Please submit the form then pay dues by clicking the button below.

Pay Tuition

OR Mail check payment to:

Temple Adas Israel
PO Box 1378
Sag Harbor NY 11963

of Sag Harbor

Hebrew School Registration

Hebrew School Online Registration Form

Please complete and submit form then follow instructions to pay tuition.

Please submit the form then pay dues by clicking the button below.