The Hochberg Academy at Temple Beth Shalom (Grades 8-12)

 

Registration 2021-2022 / 5782

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PLEASE PRINT or TYPE ALL INFORMATION CLEARLY​

Parent #1

Parent #2

If parents are divorced or separated, with whom does child reside?
Do you want emails /mailings from TBS to be sent to both parents?

Siblings:

Emergency Contacts:

  1. If I cannot be reached in an emergency, I authorize TBS to seek medical attention for my child.

  2. My child has permission to participate in all class field trips. I will be notified in advance of all trips.

  3. TBS has my permission to publish photographs taken of my child for use in publications or on website. My child will not be identified by name. I understand we will not receive financial compensation for such publicity.

Fees include: Religious School tuition, Youth Group dues (grades 8-12), light dinner. Fees do NOT include Youth Group trips.

Grades 8-12
Wednesdays 6:00-7:30

$ 200

$ 200

Amount enclosed:

BALANCE:

PLEASE CHECK ONE: [Note: No child will be turned away for financial reasons]

METHOD OF PAYMENT:

NOTE: The Hochberg Academy refunds fees only in cases of serious illness or family move.

Thanks for submitting!

Student’s Name: