JLC: 24-25 Registration - Form

By signing my name below, I agree that my child(ren) have permission to participate in the JLC of Temple Beth Am. I hereby authorize the Director of the JLC, or a person designated by the Director of the JLC, to obtain emergency medical care for my child(ren) in the event such care is needed. I give my permission for my child(ren) to receive emergency medical care by any nurse, doctor, paramedic, or member of a medical staff of a hospital licensed by the State of California. I understand that every effort will be made to notify a parent/guardian before treatment.

I certify that my child(ren) is(are) in good physical health. My child(ren) have my permission to participate in all activities that are part of the regular JLC program.

* Medical Release: Enter your name below

By typing my name, I confirm I have read, understand and agree to the above.

Were you reffered to our program by a current JLC family?

Student Enrollment Information

* How many students are you enrolling for the 2024-2025 year?

Student 1 Information

* Student 1 First Name

* Student 1 Last Name

Student 1 Nickname (if applicable)

* Student 1 Hebrew Name

* Student 1 Birthdate

If Other, please indicate preferred pronouns

* Student 1 Secular School Name

* Current Grade Enrolled (2024-2025)

Student 1 Email (if applicable)

Information will not be shared publicly. Parents will be copied on all communication to students.

Student 1 Phone (if applicable)

Information will not be shared publicly. Students will not be contacted independently from parents.

* Student 1 Allergies, Medical Conditions, or Medications

Does your child have allergies, medical conditions, or medications we need to know about?

Student 1 Allergy/Medical Conditions/Medication Details

Please describe allergies, medical conditions, and medications with dosage and timing.

* Student 1 Does your child have any learning accommodations or special learning needs?

If yes, Ellie Laycook would love to have a conversation with you before your child begins so that we are able to discuss the best ways to support them. If you are comfortable we invite you to send any documentation ahead of time to ELaycook@tbala.org.

Is there anything else we should know about your child (dietary restrictions, special needs, family arrangements affecting attendance, etc.)?

Please list any students that your child would like to be in class with (please separate with commas).

Please be advised that a variety of factors are taken into account when class groupings are determined. We appreciate your cooperation.

Current Student Photo

You can upload a maximum of 1 files.
Please upload a current photo of your child that we can share with their teacher.

* JLC Parent Association ($144)

JLC Parent Association ($144)This fee will be used to put in place several new programs, including family and parent learning. We will also use these funds for Hanukkah and Year-End presents for our incredible teaching staff.

Sunday Snack Pack

JLC will provide snacks on Sunday morning for an additional fee

Tuesday Pizza

JLC will provide pizza on Tuesday afternoons for an additional fee

Student 2 Information

* Student 2 First Name

* Student 2 Last Name

Student 2 Nickname (if applicable)

* Student 2 Hebrew Name

* Student 2 Birthdate

If Other, please indicate preferred pronouns

* Student 2 Secular School Name

* Current Grade Enrolled (2024-2025)

Student 2 Email (if applicable)

Information will not be shared publicly. Parents will be copied on all communication to students.

Student 2 Phone (if applicable)

Information will not be shared publicly. Students will not be contacted independently from parents.

* Student 2 Allergies, Medical Conditions, or Medications

Does your child have allergies, medical conditions, or medications we need to know about?

Student 2 Allergy/Medical Conditions/Medication Details

Please describe allergies, medical conditions, and medications with dosage and timing.

* Student 1 Does your child have any learning accommodations or special learning needs?

Is there anything else we should know about your child (dietary restrictions, special needs, family arrangements affecting attendance, etc.)?

Please list any students that your child would like to be in class with (please separate with commas).

Please be advised that a variety of factors are taken into account when class groupings are determined. We appreciate your cooperation.

Current Student Photo

You can upload a maximum of 1 files.
Please upload a current photo of your child that we can share with their teacher.

* JLC Parent Association ($144)

Tuesday Pizza

JLC will provide pizza on Tuesday afternoons for an additional fee

Tuesday Pizza

JLC will provide pizza on Tuesday afternoons for an additional fee

Student 3 Information

* Student 3 First Name

* Student 3 Last Name

Student 3 Nickname (if applicable)

* Student 3 Hebrew Name

* Student 3 Birthdate

If Other, please indicate preferred pronouns

* Student 3 Secular School Name

* Current grade Enrolled (2024-2025)

Student 3 Email (if applicable)

Information will not be shared publicly. Parents will be copied on all communication to students.

Student 3 Phone (if applicable)

Information will not be shared publicly. Students will not be contacted independently from parents.

* Student 3 Allergies, Medical Conditions, or Medications

Does your child have allergies, medical conditions, or medications we need to know about?

Student 3 Allergy/Medical Conditions/Medication Details

Please describe allergies, medical conditions, and medications with dosage and timing.

* Student 1 Does your child have any learning accommodations or special learning needs?

Is there anything else we should know about your child (dietary restrictions, special needs, family arrangements affecting attendance, etc.)?

Please list any students that your child would like to be in class with (please separate with commas).

Please be advised that a variety of factors are taken into account when class groupings are determined. We appreciate your cooperation.

Current Student Photo

You can upload a maximum of 1 files.
Please upload a current photo of your child that we can share with their teacher.

* JLC Parent Association ($144)

Learning Commitment

At Temple Beth Am, we are committed to lifelong Jewish learning and aim to provide all students this foundation in childhood. In order to become Bnei Mitzvah at Temple Beth Am, we expect that students commit to enroll and attend a minimum of three years of Religious education as well as be enrolled during the year of their Bnei Mitzvah. Our Bnei Mitzvah students are additionally expected to continue their Jewish education beyond their Bnei Mitzvah.

*Exceptions can be made with clergy approval

* Learning Commitment: Enter your name below

By typing my name, I confirm I have read, understand and agree to the above.

From time to time, your child’s photo may be taken in our classrooms or at special events. We use these photos in our JLC newsletter (The Buzz), synagogue newsletter (Kol Ha'Am), on social media, the Temple Beth Am website, on private Facebook groups, and in other publicity materials.

* I give my permission for my child(ren)'s photo to be used:

Congregation Community

You may have noticed that at the top of the form we begin with family information. This is intentional. The work of raising and educating Jewish children cannot be done in the school alone but is a project of the school, the family, and the community. You are not registering just your child(ren) but in fact your entire family. When you join our community and spend time learning and volunteering with us, you make a powerful statement to your child(ren) that Jewish learning is a lifelong process and that we are all on the same team in creating these experiences for them. Don’t underestimate the subtle power of this statement!

We have opportunities during the course of the year when parents are required to attend with students (Family Learning/OBKLA). Please plan to join us on these days.

In addition to those opportunities to participate, we are in need of regular volunteers to make our school work. Would you consider supporting our school in a continuing role or a limited engagement?

Continuing Opportunities (check all that apply)

Parent CommitteeTikkun Olam Event Coordination

Limited Engagements (check all that apply)

Any other skills or talents you might be willing to share?

Payment Information

In Jewish tradition, it is the job not only of parents but also of the community to provide education for children. The Temple Beth Am community is committed to this obligation. As a result, our JLC fee covers only a portion of the cost of our JLC.

There are many impediments to Jewish education but finances should never be one! We ask that every family commits to some financial contribution, however we are very happy to discuss financial aid options for any family who needs it. If you select yes, you will discuss your payment ability in a confidential meeting with a member of the YLE staff.

If you indicated a need for finacial assistance, please click "Bill to My Account" on the payment page and the totals will be adjusted when the decisions are made. Do not pay upon submission.

By writing my name below, I/we agree and understand that I am (we are) responsible for the agreed-on dues and tuition for the year of July 1, 2024 - June 30, 2025, and understand that because of necessary salary planning and budgeting for the year, the synagogue does not prorate or offer refunds for dues, fees, or tuition. I/we also agree that I/we must remain a member(s) in good standing, having fulfilled all financial commitments to Temple Beth Am in order to receive services, including school attendance, High Holy Days tickets, and/or maintaining Bnei Mitzvah dates.

All tuition must be paid in full before June 1, 2025.