Temple Micah Irving Seligman Religious School

TEMPLE MICAH IRVING SELIGMAN RELIGIOUS SCHOOL SCHOOL REGISTRATION FORM for 2014-2015

Please complete ALL information and return the form along with your check. PLEASE DROP OFF AT RELIGIOUS SCHOOL THROUGH MAY 12. After May 12th – mail to: Temple Micah, PO Box 6355, Lawrenceville, NJ 08648.

Name ______Grade/Fall ’14 ______DOB ______Name ______Grade/Fall ’14 ______DOB ______Name ______Grade/Fall ’14 ______DOB ______

$_____ Grades 1-7: 1st child – $350; 2nd & 3rd child – $295 each.

$ Grade 7, B’NAI MITZVAH CLASS (meets 3rd Tuesday of the month, 6:15-7:30 PM) 1st child - $90; 2nd child $80

$_____ Grades 8-12, HEBREW HIGH SCHOOL (meets 2nd Tuesday of the month, 6:15-8:15 PM) $145 - 1st child; $135 - 2nd child

$______Family Membership, $285 or Single Parent, $235.

$ ______Optional Donation, to support Religious School Holiday Programming, plus our year-long “Parent Class” (offered 1-2x/month, 5:30-6:15 pm on Tuesdays, lead by the Rabbi)

$ ______Optional Contribution, to PCOL/Presbyterian Church of Lawrenceville, to support our host community’s building/facility.

$_____ TOTAL (Note - your check will be deposited after July 1, 2014)

Please complete ALL information neatly. All information is required!

Parent/Guardian 1:______Parent/Guardian 2: ______Phone (Home)______Phone (Cell)______Address______City/State/Zip______Primary Email for School Mailings: ______-over- Would you like to volunteer as a Class Parent? Yes No (The class parent will serve as a contact person for the teacher/ rabbi, help coordinate Hanukkah and/or Purim class activities, coordinate end-of-year “thank you” for teachers.)

If you already have a Bar/Bat Mitzvah date (confirmed with PCOL and Rabbi Vicki) – please fill in the date:

______

Your child/children’s Hebrew name: ______

______

Contact Information, in the event of an emergency and we are unable to reach you:

Name: ______Phone (home & cell): ______

Does your child have any allergies? (Please specify)______

 Check here to grant permission for us to use your child’s photo on our website or FaceBook page.

Children will NEVER be identified by name.

Signature of Parent or Guardian ______

*If you have any questions/concerns – please contact Rabbi Tuckman via email or cell number.