Religious School Registration Form

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Section 1: Parent/Submitter Information

* Parent First Name

* Parent Last Name

* Parent Email

* Parent Phone

* Are you a current member of Temple B'nai Israel?

Please Note: Membership is required to register for our religious school. Please call the temple office at (727) 531-5829 to inquire about your membership options before filling out this form.

Section 2: Registering Your Student(s)

* How many students are you registering?

* Student 1 First Name

* Student 1 Last Name

* Student 1 Grade Level

* Student 1 DOB

* Student 1 Gender

Student 1 Allergies Or Special Medical Needs

Student 1 Hebrew Name (If Known)

Student 1 Hebrew Name English Translation (If Known)

Student 2 First Name

Student 2 Last Name

Student 2 Grade Level

Student 2 DOB

Student 2 Gender

Student 2 Allergies Or Special Medical Needs

Student 2 Hebrew Name (If Known)

Student 2 Hebrew Name English Translation (If Known)

Student 3 First Name

Student 3 Last Name

Student 3 Grade Level

Student 3 DOB

Student 3 Gender

Student 3 Allergies Or Special Medical Needs

Student 3 Hebrew Name (If Known)

Student 3 Hebrew Name English Translation (If Known)

Student 4 First Name

Student 4 Last Name

Student 4 Grade Level

Student 4 DOB

Student 4 Gender

Student 4 Allergies Or Special Medical Needs

Student 4 Hebrew Name (If Known)

Student 4 Hebrew Name English Translation (If Known)

Section 3: Emergency Contact
Must be different than Parent/Submitter above.

* Emergency Contact First Name

* Emergency Contact Last Name

* Emergency Contact Email

* Emergency Contact Phone

Section 4: Calculate Tuition

$550 - Grades PK - 7th

Total Number of PK - 7th

$550 Per Student

Your Total

Total may be split into multiple payments on the next page. We ask that you please have your tuition paid in full by December 31, 2025.

Tue, August 26 2025 2 Elul 5785

Temple B'nai Israel 1685 South Belcher Road Clearwater, FL 33764
Phone: (727) 531-5829 Email: connect@tbiclearwater.org

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