22-23 TIR Registration

* Are you a current member of Congregation Ahavath Chesed?

Temple Membership is a requirement for Grades 1 - 12. If you are not currently a member, a Temple representative will be reaching out to you to go over membership options. Please continue enrolling your student(s) at this time. Thank you.

Welcome Back to TIR! We look forward to another great year.

Section A: Family Contact Information

* First Name (Primary)

* Last Name (Primary)

* Email (Primary)

* Phone (Primary)

* Relationship to Student(s) (Primary)

* Street Address (Primary)

Street Address Line 2 (Primary)

* City (Primary)

* State (Primary)

* ZIP (Primary)

* Is there a secondary contact?

Please Select OneNoYes, at the same address as the primary contactYes, but at a different address than the primary contactIf there is a secondary contact, all emails and mailings will go to both contacts. In case of urgent need, the primary contact will be notified first

* First Name (Secondary)

* Last Name (Secondary)

* Email (Secondary)

* Phone (Secondary)

* Relationship to Student(s) (Secondary)

* Street Address (Secondary)

Street Address Line 2 (Secondary)

* City (Secondary)

* State (Secondary)

* ZIP (Secondary)

* Emergency Contact Name

* Emergency Contact Phone

* Emergency Contact Relationship

Section B: Student Enrollment Information

TIR SCHEDULE
New this year: we are happy to announce that our Prek & Kindergarten classes will be tuition-free for our youngest Jewish learners (4 yrs. old as of 9/1/22).
*Grade*	*Schedule*	*Program*	*Tuition*
PreK & Kindergarten	Sundays, 9:00am – 12:00pm	Religious School	$54 Registration Fee
1^st – 7^th Grade	Sundays, 9:00am – 12:00pm	Religious School	$750
8^th – 9^th Grade	Sundays, 12:00pm – 1:30pm	Hot Topics	$450
10^th Grade	TBD	Confirmation Class	$450
11^th – 12^th Grade	TBD	Post Confirmation	$450
9^th – 12^th Grade	Sundays, 9:00am – 12:00pm	Madrichim

Student 1 Information

* Student 1 First Name

* Student 1 Last Name

* Student 1 Birthdate

Student 1 Hebrew Name

Student 1 Nickname (if applicable)

* Student 1 Grade in Religious School

Student 1 Secular School Name

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 Special Learning Needs

Please Select OneNoYes (IEP or 504)If yes, TIR Director Jodi Klein would love to sit down with you and your child’s teacher before the school year begins so that we are able to discuss the best ways to support your child from the outset. If you are comfortable we invite you to send any documentation ahead of time to tirdirector@thetemplejacksonville.org

* Student 1 Allergies or Medications

Please Select OneNoYesDoes your child have allergies or medications we need to know about?

Student 1 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

Student 2 Information

* Student 2 First Name

* Student 2 Last Name

* Student 2 Birthdate

Student 2 Hebrew Name

Student 2 Nickname (if applicable)

* Student 2 Grade in Religious School

Student 2 Secular School Name

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 Special Learning Needs

* Student 2 Allergies or Medications

Please Select OneNoYesDoes your child have allergies or medications we need to know about?

Student 2 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

Student 3 Information

* Student 3 First Name

* Student 3 Last Name

* Student 3 Birthdate

Student 3 Hebrew Name

Student 3 Nickname (if applicable)

* Student 3 Grade in Religious School

Student 3 Secular School Name

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 Special Learning Needs

Please Select OneNoYes (IEP or 504)If yes,TIR Director Jodi Klein would love to sit down with you and your child’s teacher before the school year begins so that we are able to discuss the best ways to support your child from the outset. If you are comfortable we invite you to send any documentation ahead of time to tirdirector@thetemplejacksonville.org

* Student 3 Allergies or Medications

Please Select OneNoYesDoes your child have allergies or medications we need to know about?

Student 3 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

Student 4 Information

* Student 4 First Name

* Student 4 Last Name

* Student 4 Birthdate

Student 4 Hebrew Name

Student 4 Nickname (if applicable)

* Student 4 Grade in Religious School

Student 4 Secular School Name

Student 4 Email (if applicable)

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

Student 4 Phone (if applicable)

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

* Student 4 Special Learning Needs

* Student 4 Allergies or Medications

Please Select OneNoYesDoes your child have allergies or medications we need to know about?

Student 4 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

Section C: Release Forms

By signing my name below, my child(ren) have permission to participate in Temple Institute of Religion (TIR) at Congregation Ahavath Chesed. In consideration of my child(ren)'s acceptance as a religious school student, I hereby waive any and all claims against Congregation Ahavath Chesed, its agents and its employees that may arise out of any injury, loss or damage suffered by my child(ren) during any religious school activity. I hereby authorize the TIR Director, or person designated by the TIR Director, to obtain emergency medical care for my child(ren) in the event such care is indicated. 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 Florida. I understand that every effort will be made to notify a parent/guardian prior to treatment.

I certify that my child(ren) is(are) in good physical health. They have my permission to participate in all activities that are part of the regular religious school program. Field trips may be arranged by Temple, and transportation may include bus or vehicle driven by a classmate's parent or guardian.

* Medical Release: Enter your name below

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

Policies & COVID 19 Commitment

I acknowledge that my child(ren) will follow Congregation Ahavath Chesed's Temple policies and will adhere to the COVID 19 protocols in place.

* Policies and COVID 19 protocols Enter your name below

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

Media Release

From time to time your child’s photo may be taken in our classrooms or special events. We use these photos in the Temple newsletters, on our Temple website as well as our Facebook groups and other publicity materials.

* Media Release

Please Select OneI grant permission for my child's image to be usedI do not grant permission for my child’s image to be used

Section D: TIR 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 school alone, but is an endeavor of the school, the family and the community. You are not just registering your child(ren) for school today, but in fact your entire family. When you come in the building and spend time learning and volunteering with us, you make a powerful statement to your children that Jewish learning is a lifelong process and that we are all on the same team in creating these experiences for them.

We have several Family Learning days during the course of the year on which parents can participate in programs with students inside and outside of the Temple. Please plan to join us on these days.

Family Learning Days:
08/21/22- Opening Day
10/09/22- Sukkot Party
11/06/22- Fall Family Day
12/11/22- Hanukkah Celebration
01/15/23- Family Mitzvah Day (MLK Weekend)
02/26/23- Purim Carnival
04/02/23- Passover
05/21/23- Closing Day

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

Other Important Information to share? Authorized Pickup Person(s)?

Section E: Payment Information

* Do you require financial aid?

Please Select OneNoYesThere 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 dues paying family that may require tuition assistance. If you select yes, you will discuss your payment ability in a confidential meeting with the Accountant.
Please contact,Lynn Busch at lbusch@thetemplejacksonville.org

Financial Aid Follow-up: I understand and will contact Lynn Busch

Payment plans for TIR may be set up for membership accounts that are in good standing. Please contact the Accountant, Lynn Busch at lbusch@thetemplejacksonville.org with any questions or concerns.

New to TIR? PreK and Kindergarten students, Temple membership is not required. For all other grades please contact Lynn Busch for membership details.

By electronically signing below, I acknowledge that my child(ren)'s registration is not complete until I have paid the first month's payment.

By electronically signing below I am confirming that my child(ren)'s vaccination have not changed since last submitted. If your student is new to TIR or your student's immunization record has changed since last submitted, please provide na updated immunization record to Jodi Klein. If you have any questions about the Vaccination Policy, please contact Jodi.

By electronically signing below, I agree to the payment plan terms. ****PLEASE NOTE**** When selecting payment plan, all payments must be complete by June 30th, 2023. Please do not select more than 10 monthly payments. All plans will be adjusted accordingly.

Registration Acknowledgement Signature

Additional Contribution

Amount

Total Amount

The total reflects all students enrolled and any contribution you elected. The next screen will take you to the payment screen where you can elect to pay in full or a payment plan can be set up. A payment will be due with your enrollment submission.

2022-23 Temple Institute of Religion (TIR) Registration