Kesher Registration 24/25

The Kesher program is for grades 8 - 12.
Confirmation is for 10th graders.

You will need to complete a separate form for each child you are registering

* Email Address

* Are you a member of Temple Beth El?

Parent Information

* Parent 1 First Name

* Parent 1 Last Name

* Parent 1 Email

* Parent 1 Cell Phone

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Cell Phone

* Address

* City

* Zip

Photo Opt Out

Photo Opt OutIf you DO NOT wish your child(ren)'s picture to appear as part of a group in Temple Beth El's orTemple Emanu-El's communications or publications, please check this box.

Emergency Contact

* Emergency Contact Name

* Emergency Contact's Relationship to Student

* Emergency Contact Phone

* Emergency Contact Email

Student Information

* Student First Name

* Student Last Name

* Student prefers to be called

Student Hebrew Name

* Student Birthdate

* Secular School attending Fall 2024

* Religious School Grade Fall 2024

* Student Resides With:

If other, please specify

Student's Email

All emails sent to students will be cc'd to parent

Student's Cell Number

Please provide any additional information about your child regarding learning, social, or behavior issues to help us offer the best possible school experience:

Medical Info and Release

* Medical Release & Liability

Medical Release & Liability I hereby grant permission for my child(ren) to participate in Kesher programs, activities and events and do release Temple Beth El and its representatives from all liability arising out of my child’s participation in such activity. In addition, I, the undersigned parent/guardian of the above child(ren), do further certify that my child(ren) is physically able to participate in such activity. By selecting 'I agree' below and by enrolling your child(ren) in Kesher, you indicate your agreement to the above terms and conditions

Does your child take any prescriptions or have any medical conditions we should be aware of?

If you checked other in Allergies, please specify:

If your child carries an EpiPen, please make sure the teachers and staff are aware of where it can be found.

Payment Information

Amount Due for this Registration

Amount due for this registration. This includes TBE's $150 ShulHouse Rock fee. Confirmation fees are included for 10th grade registration. You must fill out and pay for each child separately. After you submit the first registration, you'll create a new registration form for each additional child.

As a reminder, you will need to register each child separately.

Mon, July 15 2024 9 Tammuz 5784