RS 2025-2026 Student Profile – Temple Israel of Hollywood

Preferred Name

Preferred Pronouns

Student Date of Birth(Required)

Student Grade for 2025-2026(Required)

Student Phone Number

Student Email Address

Name of Day School(Required)

Student T-Shirt Size(Required)

Please list up to 3 classmate requests.

Medical Information

Primary Health Care Insurance Provider(Required)

Policy Number(Required)

Group Number

Please describe in detail below.(Required)

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.(Required)

Please list any medications your child takes regularly.(Required)

Please describe any social/emotional/behavioral challenges your child faces.(Required)

Does your child require any special accommodations at their day school? If so, please explain below.

For example, does your child have an aide or a shadow with them everyday?