2024-2025 Religious School Registration

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Unique ID

Parent Information

Parent 1 Name(Required)

First Last

Parent 1 Cell Phone Number(Required)

Parent 1 Email Address(Required)

Parent 2 Name

First Last

Parent 2 Cell Phone Number

Parent 2 Email Address

Student Information

Student Registration

Student Name	Preferred Name	Preferred Pronouns	Student Date of Birth	Student Grade for 2024-2025	Student Phone Number	Student Email Address	Name of Day School	Student T-Shirt Size	Does your child have any medical history we should know about?	Please describe in detail below.	Does your child have any allergies?	Please list ANY reactions (both major and minor) and what protocols should be taken in case of allergic reaction. Please indicate if teacher, administration, or both should see this.	Does your child take any medications regularly?	Please list any medications your child takes regularly.	Does your child carry an Epipen?	Please check any medications/creams we are allowed to administer to your child.	Please describe any social/emotional/behavioral challenges your child faces.	Actions

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Health Insurance Information

Medical Release(Required)

I agree to the medical release below

In case of emergency, Temple Israel of Hollywood School’s procedure will be to call 9-1-1 if necessary, and if dispatched, to follow the advice of emergency and medical professionals, and attempt to contact the parent(s) at home or work. If unable to reach either parent, we will attempt to contact the next person listed on their emergency contact list. Parents agree that they will not hold the school financially responsible in any way for any emergency care, transportation, hospitalization, or treatment of student. TIOH Schools do not provide medications, including over-the-counter medication to students. If your child requires medication to be administered during school hours, special arrangements need to be made through the school office. Any arrangements must include a doctor’s prescription and/or instructions.

Emergency Contacts and Authorized Pickups

All emergency contacts are considered authorized pickups for your child/ren. You may add additional authorized pickups in the section below.

Emergency Contact 1 Full Name(Required)

Emergency Contact 1 Relationship(Required)

Emergency Contact 1 Cell Phone Number(Required)

Emergency Contact 2 Full Name(Required)

Emergency Contact 2 Relationship(Required)

Emergency Contact 2 Cell Phone Number(Required)

Emergency Contact 3 Full Name(Required)

Emergency Contact 3 Relationship(Required)

Emergency Contact 3 Cell Phone Number(Required)

In the case of a natural disaster or other emergency (including but not limited to evacuation, etc.) I authorize my child/ren to be dismissed to any Religious School parent.(Required)

Yes

Authorized Pickup 1 Full Name

Authorized Pickup 1 Cell Phone Number

Authorized Pickup 2 Full Name

Authorized Pickup 2 Cell Phone Number

Authorized Pickup 3 Full Name

Authorized Pickup 3 Cell Phone Number

Authorized Pickup 4 Full Name

Authorized Pickup 4 Cell Phone Number

Temple Membership Information

Membership Status(Required)

I am a new member of TIOH and need to submit my information.

I am a current member of TIOH (this will open the membership updates form in case you need to update any information).

Membership Application Form

Adult Family Member 1 Full Name	Adult Family Member 2 Full Name	Home Address	Marital Status	Wedding Anniversary (if applicable)	How did you hear about TIOH? (Please check all that apply)	How Hear Other	Reason(s) for joining (Please check all that apply)	Join Reason Other	Areas of interest (Please check all that apply)	Other Areas of Interest	If applicable, please list present affiliations in LA civic/cultural clubs and Jewish/community organizations.	Name	Preferred Name or Nickname (if different from above)	Maiden Name (if applicable)	Preferred Pronouns	Other Preferred Pronouns	Date of birth	Email	Cell Phone	Home Phone	Occupation/Profession	Business Name	What is your religious background?	Current or previous affiliation with religious institutions	Please list any relationships you have to any member(s) of TIOH	Would you like to add a spouse/partner?	Name	Preferred Name or Nickname (if different from above)	Maiden Name (if applicable)	Preferred Pronouns	Other Preferred Pronouns	Date of birth	Email	Cell Phone	Occupation/Profession	Business Name	What is their religious background?	Current or previous affiliation with religious institutions	Please list any relationships you have to any member(s) of TIOH	Are any of your children under the age of 18?	Are any of your children OVER 18 years of age?	Name	Maiden Name (if applicable)	Date of birth	Preferred Pronouns	Other Preferred Pronouns	Current School (College/University) or Occupation	Expected graduation year	Cell Phone	Email	Address	Name of spouse / partner (if applicable)	Would you like to add another child OVER 18?	Name	Maiden Name (if applicable)	Date of birth	Preferred Pronouns	Other Preferred Pronouns	Current School (College/University) or Occupation	Expected graduation year	Cell Phone	Email	Address	Name of spouse / partner (if applicable)	Would you like to add another child OVER 18?	Name	Maiden Name (if applicable)	Date of birth	Preferred Pronouns	Other Preferred Pronouns Adult Child 3	Current School (College/University) or Occupation	Expected graduation year	Cell Phone	Email	Address	Name of Spouse / Partner (if applicable)	Would you like to add another child OVER 18?	Name	Maiden Name (if applicable)	Date of birth	Preferred Pronouns	Other Preferred Pronouns	Current School (College/University) or Occupation	Expected graduation year	Cell Phone	Email	Address	Name of Spouse/Partner (if applicable)	Would you like to submit Yahrzeit (anniversary of death) information for a loved one?	Name	Date of Death	Relationship to member	Would you like to add Yahrzeit information for an additional loved one?	Name	Date of Death	Relationship to member	Would you like to add Yahrzeit information for an additional loved one?	Name	Date of Death	Relationship to member	Would you like to add Yahrzeit information for an additional loved one?	Name	Date of Death	Relationship to member	Business Website	LinkedIn Profile	Business Website	LinkedIn Profile	Actions

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Maximum number of entries reached.

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Membership Update Form

Name	Please select the areas that have changed	Updated Name (or Preferred Name)	Updated Home Mailing Address	What type of phone number are you updating?	Updated Cell Phone Number	Updated Home Phone Number	Updated Email	Dependents	Updated Marital Status	Occupation/Profession	Business Name	Business Website	LinkedIn Profile	Updated Yahrzeit Information	Other Information to Update	Membership status update	Actions

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Maximum number of entries reached.

Click “Add Entry” above to enter your updated membership information. Continue to the next page if you do not wish to update any information.

Religious School Annual Giving

Please make your donation now to our Annual 24-25 Religious School Giving Campaign and ensure the educational and programmatic experiences we provide are deeply rich and fully accessible to everyone who wants to join our vibrant community. Your support will help deepen our students’ connection to Jewish values and traditions, and bring Jewish history, holidays, and Hebrew language to life. Our goal is 100% participation!

Make your Religious School Annual Giving Pledge(Required)

$5,000 (Become a Limmud Society member)

$3,600 (Become a Limmud Society member)

$1,800 (Become a Limmud Society member)

$1,000 (Become a Limmud Society member)

$500

$360

$180

I would like to donate a different amount.

I do not wish to donate at this time.

Join the Limmud Society: With your gift of $1,000+, you will join our new Limmud Society, and enjoy exclusive Limmud Society benefits and an invitation to a private TIOH Patron event. TIOH Patrons embody the mission of TIOH. This historic group of sustaining members make a critical difference by increasing their annual contribution above standard membership dues.

I would like to donate…(Required)

Credit Card Fee

I wish to cover credit card fees for the temple by increasing my total by 3%

Credit Card Fee

$0.00

Total

Credit Card(Required)

American Express

Discover

MasterCard

Visa

Supported Credit Cards: American Express, Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

Billing Address(Required)

Street Address City State ZIP Code