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

Thu, January 15 2026 26 Tevet 5786

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

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