RELIGIOUS SCHOOL REGISTRATION - Moses Montefiore Congregation

309-662-3182

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Phone: 309-662-3182 Email: MMTemple1882@gmail.com

Religious School Registration

Please fill out a registration for EACH of your children attending MMT Religious School. Our registration fees for 2025-2026 are as follows: Pre-K Program: $300 per child Hebrew/Judaica: $500 Confirmation Class: $200 *Additionally, there will be a $25 annual snack fee per child

How many student's will you be registering?(Required)

1

2

3

Student #1 Name(Required)

First Last

Student #2 Name(Required)

First Last

Student #3 Name(Required)

First Last

Hebrew Name #1

If you have questions about your student's Hebrew name, please speak with the congregational Rabbi.

Hebrew Name #2

If you have questions about your student's Hebrew name, please speak with the congregational Rabbi.

Hebrew Name #3

If you have questions about your student's Hebrew name, please speak with the congregational Rabbi.

Birth Date #1(Required)

MM slash DD slash YYYY

Birth Date #2(Required)

MM slash DD slash YYYY

Birth Date #3(Required)

MM slash DD slash YYYY

#1 Grade in Secular School (2025-2026 School Year)(Required)

#2 Grade in Secular School (2025-2026 School Year)(Required)

#3 Grade in Secular School (2025-2026 School Year)(Required)

#1 Secular School Enrollment(Required)

Enter the name of the school you attend.

#2 Secular School Enrollment(Required)

Enter the name of the school you attend.

#3 Secular School Enrollment(Required)

Enter the name of the school you attend.

Has student #1 been consecrated?(Required)

Yes

No

I Don't Know

Has student #2 been consecrated?(Required)

Yes

No

I Don't Know

Has student #3 been consecrated?(Required)

Yes

No

I Don't Know

Will student #1 have a B Mitzvah?(Required)

Yes

No

I Don't Know

Will student #2 have a B Mitzvah?(Required)

Yes

No

I Don't Know

Will student #3 have a B Mitzvah?(Required)

Yes

No

I Don't Know

Student's Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Parent/Guardian Name:(Required)

First Last

Parent/Guardian Address (If different than student)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Parent/Guardian Phone Number(Required)

BEST Contact Email(Required)

Additional Parent/Guardian

First Last

Additional Parent/Guardian Address (if different)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Please describe any allergies your student(s) may have:

If your student(s) takes any medication that may affect their participation in Religious School, please describe:

Tell us about any challenges or needs for your student(s) that our religious school should know about.

ie. challenges in turn-taking, reactions to loud sounds, not yet reading, eloping, transitions, etc. You may also tell about any diagnoses that you would like us to know.

Tell us about some things that are motivating for the student(s)

ie. positive praise, stickers, smiles, high fives, snack rewards, TV shows, games, movies, etc.

Parent Permission Slip (activities)(Required)

I hereby consent to my student's participation in all extracurricular activities which the Religious School may engage in during the current school year. (Any activity which requires transportation by vehicle will include its own additional permission slip).

Yes

No

Parent Permission Slip (Media)(Required)

Photos of students and video/audio recordings or student projects and performances may be posted online and used by the religious school for temple bulletins and website information. Identifying information will be excluded. Parents wishing to exempt their students from any published media may do so.

Yes, I give permission for photographs and recordings.

No, I do not give permission for photographs and recordings.

Consent for Emergency Medical Care(Required)

In case of accident or serious illness, I request the school contact me. If the school is unable to reach me, I hereby authorize the Religious School of MMT to seek medical care, including transportation to the emergency room of the closest hospital. I agree to assume all responsibility for expenses incurred, including transportation.

Yes, I give permission for administering emergency medical care

No, I do not give permission for administering emergency medical care

Primary Care Physician(Required)

Electronic Signatures

Parent Guardian Signature (Religious School Agreement to Participate)(Required)

Date of Signature(Required)

MM slash DD slash YYYY

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