Hochberg Academy Registration 2023-24 - Form

The TBS Logo - A blue Star of David with the Hebrew text

Registration 2023-2024
Welcome to our new online school registration form. This form allows you to register BY FAMILY. Contact Cantor Lianna, cantorlianna@gmail.com or (505) 309-0573, with any questions.

Email Address of Person Completing Form

FAMILY INFORMATION

* New / Returning Family

Does your family belong to Temple Beth Shalom?

* Parent/Guardian #1 Last Name

* Parent/Guardian #1 First Name

* Relationship to Student(s)

* Parent/Guardian #1 Cell Phone

Parent/Guardian #1 Email

Parent/Guardian #1 Address

City, State, Zip

Parent/Guardian #2 Last Name

Parent/Guardian #2 First Name

Relationship to Student

Parent/Guardian #2 Cell Phone

Parent/Guardian #2 Email

* Parent/Guardian #2 Address

City, State, Zip

Should we send communication to both parents/guardians?

Yes, please email both parentsNo, please only communicate with parent/guardian #1

* May we take & use your child(ren)'s photo?

YES, for any useNO, not for any use

* Emergency Contact Information

Please provide the name and number of a local friend or family member who can be contacted in the case of emergency (if both parents are unreachable).

STUDENT INFORMATION

* Student #1 First Name

Student #2 First Name

Student #3 First Name

Student #4 First Name

* Student #1 Last Name

Student #2 Last Name

Student #3 Last Name

Student #4 Last Name

Student #1 Pronouns

Student #2 Pronouns

Student #3 Pronouns

Student #4 Pronouns

* Student #1 Grade in the '23-'24 school year

Student #2 Grade in the '23-'24 school year

Student #3 Grade in the '23-'24 school year

Student #4 Grade in the '23-'24 school year

Student #1 Hebrew Name

Student #2 Hebrew Name

Student #3 Hebrew Name

Student #4 Hebrew Name

Hebrew name includes parent name(s) as well. Feel free to leave this blank if you haven't chosen a Hebrew name for your child yet, and let Cantor Lianna know if you want help choosing a name for them!

* Student #1 Date of Birth

Student #2 Date of Birth

Student #3 Date of Birth

Student #4 Date of Birth

* Student #1's secular school

Student #2's secular school

Student #1's Doctor

Name & Contact Info

Student #2's Doctor

Student #1's Doctor

Name & Contact Info

Student #2's Doctor

Student #3's Doctor

Student #4's Doctor

We are kosher-style - We do not serve pork or shellfish, and try not to have meat and dairy in the same meal. We also do not serve food containing nuts or peanuts at the religious school, but the synagogue is not a nut-free environment

Student #1 Allergies or medical conditions

Student #2 Allergies or medical conditions

Student #3 Allergies or medical conditions

Student #4 Allergies or medical conditions

Does Student #1 have an IEP?

YesNo

Does Student #2 have an IEP?

YesNo

Does Student #3 have an IEP?

YesNo

Does Student #4 have an IEP?

YesNo

If yes, what accommodations help Student #1 succeed?

If yes, what accommodations help Student #2 succeed?

If yes, what accommodations help Student #3 succeed?

If yes, what accommodations help Student #4 succeed?

Is there anything else you want us to know about your children, particularly about their Jewish experiences or their social, emotional and behavioral needs?

TUITION

The Hochberg Academy is partially underwritten by a generous grant from Stephen and Jane Hochberg. The family contribution per student is $250. No student will ever be turned away for lack of funds.

Do you need a scholarship?

YesNoNo young person will ever be turned away due to financial need. At the same time, providing quality educational experiences for our youth has a significant cost. We appreciate you paying full tuition if you are able, and as much as you can if you are not.

If you requested a scholarship, how much are you able to pay?

Please let us know if there are any circumstances or financial needs we should know about. Cantor Lianna will be in touch and let you know of the final decisions regarding scholarships.

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