Gilner Religious School Registration 2025-26 - Form

2025-2026 REGISTRATION FORM

Today's Date

Below are both Returning and New Student Registration forms
Please complete the one form applicable to you.

Both Returning & New Student must complete the Photography & Videography Permission and the Tuition Payment Form/Fee Schedule

RETURNING STUDENT REGISTRATION
2025-2026

All Second(2nd) through Seventh (7th) graders will meet in a small group one afternoon a week for Hebrew Instruction that will last 45 minutes

Please scroll down to complete the Permission for Photography & Videography 2025-2026 and the Tuition Payment Form/Fee Schedule before submitting

Student #1 Full Name

Student #1 Hebrew Name

Student #2 Full Name

Student #2 Hebrew Name

Student #3 Full Name

Student #3 Hebrew Name

Parent One email address and phone number

Parent Two email address and phone number

STUDENT REGISTRATION FOR NEW STUDENTS

2025-2026

Our Sunday program is in person and meets from 9:15am-12:15pm. All 2nd through 7th graders will meet in a small group one afternoon a week for midweek Hebrew instruction that will last 45 minutes.

Beth Shalom schools require all children to be up-to-date on immunizations unless there is a medical reason to avoid vaccinations

Student #1 Full Name

Student #1 Hebrew Name

Student #2 Full Name

Student #2 Hebrew Name

Student #3 Full Name

Student #3 Hebrew Name

Home Address, City, State, Zip

Home Phone

Student #1 Birthdate

Student #2 Birthdate

Student #3 Birthdate

Student #1 Age

Student #2 Age

Student #3 Age

Parent's Names

Parent One Hebrew Name

Parent Two Hebrew Name

Parent One Occupation

Parent One Cell Phone

Parent Two Occupation

Parent Two Cell Phone

Please check below who the student lives with

If Other, advise whom the student is living with

Parent One Email

Parent Two Email

Student #1 - Public/Private School attending in Fall 2025

Student #2 - Public/Private School grade attending Fall 2025

Student #3 - Public/Private School attending Fall 2025

Student #1 - Beth Shalom Religious School Grade attending Fall 2025

Student #2 - Beth Shalom Religious School Grade attending Fall 2025

Student #3 - Beth Shalom Religious School Grade attending Fall 2025

Student #1 - What Grade did you start Religious School?

Student #2 - What Grade did you start Religious School?

Student #3 - What Grade did you start Religious School?

If new to Beth Shalom, previous Religious School name and city

Please list any Special Stipulations Regarding Carpool Pickup Arrangement

Parent(s) Signature(s)

Date

CONGREGATION BETH SHALOM GILNER RELIGIOUS SCHOOL EMERGENCY MEDICAL INFORMATION
2025-2026

If you have a child with special needs, please complete the unique information for each

Student #1 - Please list any special needs or requirements that your child may have, including any special educational needs or medications. Please include any special classes/programs that he/she attends. This is so we can serve your child appropriately

Student #2 - Please list any special needs or requirements that your child may have, including any special educational needs or medications. Please include any special classes/programs that he/she attends. This is so we can serve your child appropriately

Student #3 - Please list any special needs or requirements that your child may have, including any special educational needs or medications. Please include any special classes/programs that he/she attends. This is so we can serve your child appropriately

* In case of emergency, please call

If we cannot reached Parent One or Two, please list whom we should call- full name & phone number

Student # 1 - Allergies to Medication or Food- Please advise

Student # 2 - Allergies to Medication or Food- Please advise

Student # 3 - Allergies to Medication or Food- Please advise

Please list any other information you feel we should know about your child(ren)

If i cannot be reached, i give my permission for basic first aid measures for my child and in the case of more serious injury, for emergency medical treatment to be sought - Parent- please sign and date

PERMISSION FOR PHOTOGRAPY & VIDEOGRAPHY
2025-2026

Student #1 - Check the box if you give permission for your child(ren) to be photographed at Gilner Religious School, synagogue events and/or field trips. These photographs may be used by Congregation Beth Shalom for educational purposes, congregational advertising, the congregation's website, and/or on the congregation's or the religious school social media pages.

Student #2 - Check the box if you give permission for your child(ren) to be photographed at Gilner Religious School, synagogue events and/or field trips. These photographs may be used by Congregation Beth Shalom for educational purposes, congregational advertising, the congregation's website, and/or on the congregation's or the religious school social media pages.

Student #3 - Check the box if you give permission for your child(ren) to be photographed at Gilner Religious School, synagogue events and/or field trips. These photographs may be used by Congregation Beth Shalom for educational purposes, congregational advertising, the congregation's website, and/or on the congregation's or the religious school social media pages.

Please Mark All That Apply

Yes, it is okay to use my child's image in pictures used for Beth Shalom marketing and on the website (names will not be included)Yes, it is okay to use my child's image on any closed Beth Shalom social network pagesYes, it is okay to use my child's images on open Beth Shalom social network pages

Parent One Signature

Parent Two Signature

Date

TUITION PAYMENT FORM / FEE SCHEDULE
2025-2026

In order for your child to be admitted to Religious School, all prior year balances must be paid in full. Please call Roberta London at 770-399-5300 if you have any questions.

Please note: Multiple student tuition reduction - $25 less for second student, $35 less for third. All Students entering 4th through 7th grades must be members.

Student #1 - Please List Last Name, First Name

Student #1 - Please enter Grade

Student #1- Please enter the fee information as per the above tuition payment form/fee schedule

Student #1 - Check the box for the teachers' gift ($20) that will be added to your bill

Student #2 - Please list Last Name, First Name

Student #2 - Please enter Grade

Student #2 - Please enter the fee information as per the above tuition payment form/fee schedule

Student #2 - Check the box for the teachers' gift ($20) that will be added to your bill

Student #3 - Please list Last Name, First Name

Student #3- Please enter Grade

Student #3 - Please enter the fee information as per the above tuition payment form/fee schedule

Student #3 - Check the box for the teachers' gift ($20) that will be added to your bill

Parents Full Name/Names

Please select from the following payment schedule

Please note the following:

1. If paying by check, checks must be received in the office no later than July 25, 2025.

2. Continuing Students, please fill out the next box.

3. New Students or change in payment method, please call Roberta London in the office at 770-399-5300

Continuing Students- If paying by E-check or credit card (2.5% fee), check the box if you are using the same payment method

Parent Signature and Date