Sign In
Forgot Password
or Sign In With
Powered By
ShulCloud
Log in
Log in
Home
Donate
About
I'm New Here
Hazzan Sered-Lever
Board of Trustees
Welcoming Diversity
Joining Mekor Shalom
Kashrut at Mekor Shalom
Learn
Mekor Shalom Jewish Learning Program
B'nai Mitzvah at Mekor Shalom
Adult Lifelong Learning
Listen In
Contact
Contact Mekor Shalom
For the Media
In the News
Calendar
Involvement
Teddy Bear Shabbat
Community Involvement: Social Action Team Projects
Mekor Shalom's Frequent Chaier Program
Community
Advertise with Mekor Shalom
Kosher in Tampa
Giving
Donate
Home
Donate
Mekor Shalom Religious School Registration 2023-24
Please verify reCaptcha before submitting the form.
Welcome to Mekor Shalom Religious School Registration
for the 2023-24 school year!
Mekor Shalom is proud of the strong Jewish education the Religious School provides. Each student experiences Jewish learning in a safe, nurturing, meaningful, and engaging environment.
Religious School Class Schedule:
Sundays: Grades K-7 meet at Mekor Shalom, 9:30 a.m. to 12:00 p.m.
Wednesdays: Grades 3-7 meet via Zoom, 5:00-6:30 p.m.
Please fill out this form, even if you have filled out a registration
form in prior years.
Student #1
First Name
Last Name
Preferred Name:
Pronouns:
Please indicate (e.g. She/Her/Hers, He/Him/His, They/Them/Theirs, a combination):
Grade in school
Please list any food allergies, medical concerns, and medications:
Please share any circumstances or concerns related to your child’s learning style and/or request a meeting) to discuss:
Once you have entered this information for each student enrolling, please continue on to the next section.
Student #2
First Name
Last Name
Preferred Name:
Pronouns:
Please indicate (e.g. She/Her/Hers, He/Him/His, They/Them/Theirs, a combination):
Grade in school
Please list any food allergies, medical concerns, and medications:
Please share any circumstances or concerns related to your child’s learning style (and/or request a meeting) to discuss:
Student #3
First Name
Last Name
Preferred Name:
Pronouns:
Please indicate (e.g. She/Her/Hers, He/Him/His, They/Them/Theirs, a combination):
Grade in school
Please list any food allergies, medical concerns, and medications:
Please share any circumstances or concerns related to your child’s learning style and/or request a meeting) to discuss:
Student #4
First Name
Last Name
Preferred Name:
Pronouns:
Please indicate (e.g. She/Her/Hers, He/Him/His, They/Them/Theirs, a combination):
Grade in school
Please list any food allergies, medical concerns, and medications:
Please share any circumstances or concerns related to your child’s learning style and/or request a meeting) to discuss:
Adult #1:
First Name
Last Name
Email Address:
Best contact phone number:
Adult #2:
First Name
Last Name
Email Address:
Best contact phone number:
Adult #3:
First Name
Last Name
Email Address:
Best contact phone number:
Adult #4:
First Name
Last Name
Email Address:
Best contact phone number:
Name:
Relationship to Student(s):
Best Contact Phone Number:
Please check if contact may pick up student(s) from school:
Please check if contact may pick up student(s) from school:
Name:
Relationship to Student(s):
Best Contact Phone Number:
Please check if contact may pick up student(s) from school:
Please check if contact may pick up student(s) from school:
Name of Physician:
Physician's Phone Number:
Tuition:
K-2nd
grade students,
$500
/school year
3rd-7th
grade students,
$750
/school year
There is a
$50
discount
if you elect to pay the entire year's tuition in full by the start of the school year.
There is also a
$50 discount
for the second and successive student(s) enrolled (the first student is still full price).
Includes a book/supply fee and a snack fee (for the small drink and snack provided each week when classes are in person).
If you are making a tuition payment today (either whole or in part),
please enter the amount below. If not, please leave it blank. Thank you.
Religious School Tuition to Be Paid Today (if applicable):
Photographs:
Please Select One
I agree.
I do not agree.
I give permission to Congregation Mekor Shalom to photograph my child(ren) and use image(s) for publication purposes whether electronic, print, digital, or electronic publishing via the Internet. Child(ren) will not be tagged in any images shared on official Mekor Shalom social media accounts.
Medical Release:
I hereby give permission for my/our child(ren):
*
Please list child(ren)'s name(s):
to participate in the programs at Mekor Shalom including off campus trips. In the event of an emergency, surgical or otherwise, and I cannot be reached, I hereby give permission for my child to be transported to the nearest medical facility and specifically authorize the representative of Congregation Mekor Shalom to select a physician and/or authorize medical treatment, including hospitalization, anesthesia, injection, surgery or other measures which he/she feels are in the best interest of my child.
Congregation Mekor Shalom is hereby released and held harmless from any claim, judgment, awards, settlements, or damages to any person or property arising directly or indirectly out of my child’s participation in the programs at Mekor Shalom, including off campus trips or the Congregation’s selection of physician, hospital, or any other medical service for my child in a medical emergency, or in connection with therein during of any such medical treatment.
*
I agree.
I agree.
By checking the “I Agree” checkbox, I agree and it is my intent to electronically sign and electronically submit this Authorization. I understand that by checking the “I agree” checkbox, I will be applying my electronic signature to this Authorization and that I will be bound with the same force and effect as if I had signed this Authorization on paper by hand.
*
Please enter your name:
So glad to have your child(ren) participating in Religious School at Mekor Shalom!
It is a privilege for Mekor Shalom to provide a safe, nurturing, and engaging educational
environment for each student who is enrolled in the program.
Thank you for the opportunity to teach your child(ren)!
Sun, December 22 2024 21 Kislev 5785
