Rabbi Albert I. Gordon Religious School

Student's Name
Last *

First Name *

Middle Name

Hebrew Name

Male/Female *

Male Female

Elementary School *

Grade (fall 2011) *

Number of Other Caretakers
(e.g. nanny, sitter, grandparent) *

Enter a number between 0 and 4.

Number Siblings
*

Enter a number between 0 and 5.

Other Caretaker #1: Name

Relationship

Other Caretaker #2: Name

Relationship

Other Caretaker #3: Name

Relationship

Other Caretaker #4: Name

Relationship

Sibling #1: Name

Age

Grade

Sibling #2: Name

Age

Grade

Sibling #3: Name

Age

Grade

Sibling #4: Name

Age

Grade

Sibling #5: Name

Age

Grade

Other Jewish Education
If new to Temple Emanuel, has your child attended another synagogue school or day school?

No Yes

Other School Name

Camp Experience (Summer of 2011)
Jewish Day Camp?

No Yes

Jewish Day Camp Name

Jewish Overnight Camp?

No Yes

Jewish Overnight Camp Name

Parent Information

Parent 1 Name *

Parent 2 Name *

Parent Address is Different from Student's

No Yes

Parent Address is Different from Student's

No Yes

Email *

Email

Primary Email Address

Parent 1 Parent 2 Both Use Alternate Email Addr

We prefer to send only one email per family unless you request otherwise.

Alternate Email Address

Religious Background *

Is child's birth mother Jewish?

No Yes

Has child been converted?

No Yes

Where? When?

Other Information

Class Placement Policy: Would you like to provide input regarding class placement?

No Yes

We believe that appropriate class placement is very important. The Religious School staff puts much time and thought into assigning students to classes with the goal of creating an optimal learning environment for all students. Our objective is for every student to be successful in a supportive and challenging educational setting.

A team consisting of the school director, the current grade teachers, and the incoming grade teachers carefully consider the following factors in making classroom assignments:

•Class size and gender balance
•Academic strengths and learning styles
•Peer relationships
•Individual learning needs

Parents may use this field to offer input regarding classroom placement that includes your child’s learning style and a brief list of peers who would enhance your child’s learning experience. This information will be considered along with the above criteria. Final decision on student class placement will be made by the school director.
website.

Class Placement Information

Special Needs: Does your child have special needs?

No Yes

Does your child have any emotional and/or familial issues of which we should be aware?

No Yes

Please describe emotional and/or familial issues

Does your child have any learning issues of which we should be aware?

No Yes

Please describe learning issues

Does your child have difficulty paying attention, staying focused or other behavioral concerns of which we should be aware?

No Yes

Please describe

Is there a behavior support plan in place at the school?

No Yes

Does your child have an IEP?

No Yes

If yes, please submit your child's IEP to the Religious School office.

Does your child have a 504 plan?

No Yes

If yes, please submit your child's 504 plan to the Religious School office.

Does your child receive support services?

No Yes

Please describe support services

Financial Assistance : Do you anticipate needing tuition scholarship assistance?

No Yes

If yes, please complete the Abatement Certification section of the Temple Emanuel Membership Booklet for the current year and return it to Amy B. Klein, President, (abklein@inis.com) or Michael Cantor, Executive Director, 617-558-8110 (mcantor@templeemanuel.com)

Ok to Submit? (Please type "Yes" then click "Submit") *

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