TLC Registration

We are already excited for the 2023-2024 year at The Learning Center. It is bound to be a wonderful year, as we learn, explore, pray, and grow together!

You must be a member of The Temple to register for The Learning Center.

TLC Registration 2023-2024

Parent/Guardian 1

Parent/Guardian 1 (Primary Contact)(Required)

First Last

Parent/Guardian 1 Hebrew Name

Parent/Guardian 1 Address(Required)

Street Address Address Line 2 City State ZIP Code

Parent/Guardian 1 Email(Required)

Parent/Guardian 1 Primary Phone Number(Required)

Parent/Guardian 1 Alternate Phone Number

Parent/Guardian 1 Spouse Name (If Applicable)

First Last

With whom is the learner's primary residence?(Required)

Both

Parent/Guardian 1

Parent/Guardian 2

Parent/Guardian 2 (Primary Contact)

First Last

Parent/Guardian 2 Hebrew Name

Parent/Guardian 2 Address

Street Address Address Line 2 City State ZIP Code

Parent/Guardian 2 Email

Parent/Guardian 2 Primary Phone Number

Parent/Guardian 2 Alternate Phone Number

Parent/Guardian 2 Spouse Name (In Applicable)

First Last

Emergency Contacts

Our policy is to call parents/guardians listed above first. We kindly request that you provide two emergency contacts in case you are not available.

Emergency Contact 1 Name(Required)

First Last

Emergency Contact 1 Phone(Required)

Emergency Contact 1 Relationship To Learner(s)(Required)

Emergency Contact 2 Name(Required)

First Last

Emergency Contact 2 Phone(Required)

Emergency Contact 2 Relationship To Learner(s)(Required)

Learner Information

Learner 1 Full Name(Required)

First Last

Learner 1 Hebrew Name(Required)

Write n/a if no Hebrew name.

Learner 1 Pronouns

Learner 1 Email (If Applicable)

Learner 1 Mobile Phone Number (If Applicable)

Learner 1 Birthdate(Required)

Learner 1 Grade(Required)

Learner 1 School(Required)

Learner 1 School District(Required)

Write n/a if private school.

Learner 1 Allergies(Required)

Write n/a if none.

Learner 1 Medical Issues(Required)

Write n/a if none.

Learner 1 Are there social/emotional challenges about which it would be helpful for us to know?

Learner 1 Are there there any learning challenges about which it would be helpful for us to know?

Learner 1 Does your learner have an IEP or 504 Plan?(Required)

If yes, please email your summary page to ggrischkan@ttti.org

Yes

Learner 1 Session Choice(Required)

Learner 1 Hebrew Choice(Required)

All learners in Grades 3-6 must also choose either Wednesday Hebrew or Virtual Hebrew. Wednesday Hebrew is 4:00-5:30pm. Virtual Hebrew is a weekly 1-to-1 20 minute tutoring session scheduled in conjunction with The Learning Center.

Learner 1 Fees(Required)

Do you have another learner you'd like to enroll?(Required)

Yes

Learner 2

Learner 2 Full Name(Required)

First Last

Learner 2 Hebrew Name(Required)

Write n/a if no Hebrew name.

Learner 2 Pronouns

Learner 2 Email (If Applicable)

Learner 2 Mobile Phone Number (If Applicable)

Learner 2 Birthdate(Required)

Learner 2 Grade(Required)

Learner 2 School(Required)

Learner 2 School District(Required)

Write n/a if private school.

Learner 2 Allergies(Required)

Write n/a if none.

Learner 2 Medical Issues(Required)

Write n/a if none.

Learner 2 Are there social/emotional challenges about which it would be helpful for us to know?

Learner 2 Are there there any learning challenges about which it would be helpful for us to know?

Learner 2 Does your learner have an IEP or 504 Plan?(Required)

If yes, please email your summary page to ggrischkan@ttti.org

Yes

Learner 2 Session Choice(Required)

Learner 2 Hebrew Choice(Required)

Learner 2 Fees(Required)

Do you have another learner you'd like to enroll?(Required)

Yes

Learner 3

Learner 3 Full Name(Required)

First Last

Learner 3 Hebrew Name(Required)

Write n/a if no Hebrew name.

Learner 3 Pronouns

Learner 3 Email (If Applicable)

Learner 3 Mobile Phone Number (If Applicable)

Learner 3 Birthdate(Required)

Learner 3 Grade(Required)

Learner 3 School District(Required)

Write n/a if private school.

Learner 3 Allergies(Required)

Learner 3 Medical Issues(Required)

Learner 3 Are there social/emotional challenges about which it would be helpful for us to know?

Learner 3 Are there there any learning challenges about which it would be helpful for us to know?

Learner 3 Does your learner have an IEP or 504 Plan?

Yes

Learner 3 Session Choice(Required)

Learner 3 Hebrew Choice(Required)

Learner 3 Fees(Required)

Do you have another learner you'd like to enroll?(Required)

Yes

Learner 4

Learner 4 Full Name(Required)

First Last

Learner 4 Hebrew Name(Required)

Write n/a if no Hebrew name.

Learner 4 Pronouns

Learner 4 Email (If Applicable)

Learner 3 Mobile Phone Number (If Applicable)

Learner 4 Birthdate(Required)

Learner 4 Grade(Required)

Learner 4 School

Learner 4 School District(Required)

Write n/a if private school.

Learner 4 Allergies(Required)

Learner 4 Medical Issues(Required)

Learner 4 Are there social/emotional challenges about which it would be helpful for us to know?

Learner 4 Are there there any learning challenges about which it would be helpful for us to know?

Learner 4 Does your learner have an IEP or 504 Plan?(Required)

Yes

Learner 4 Session Choice(Required)

Learner 4 Hebrew Choice(Required)

Learner 4 Fees(Required)

Permissions

By registering, I give permission for my child(ren) to be photographed for use in Temple materials and promotions. If you have questions or concern, please contact Gloria Grischkan.

I give The Temple-Tifereth Israel permission to escort my child(ren) within walking distance of their learning activities.(Required)

Yes

I give permission for our contact information to be included and distributed on a grade level roster to encourage temple friendships.(Required)

Yes

Learner Pick Up(Required)

Please indicate whether you will be coming into the building to pick your learner(s) or picking up outside in the car pick up line? Additional information will be sent to those families that will utilize the car pick up line.

Pick up inside

Carpool line

EMERGENCY CONSENT: In the event reasonable attempts to contact me have been unsuccessful, I hereby give my consent for the administration of any treatment deemed necessary by a licensed physician or dentist and the transfer of my child to any hospital reasonably accessible. This authorization does not cover major surgery unless the medical opinions of two other licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery.(Required)

Yes

REFUSAL TO GRANT CONSENT: I DO NOT give my consent for emergency medical treatment of my child. In the event of illness or injury requiring emergency treatment, I wish The Learning Center to take the following action:

Totals and Donations

At least one of my learners is enrolled in Shabbaton.(Required)

(Shabbaton Snack Fee is assessed one time per family.)

Yes, at least one of my learners is enrolled in Shabbaton

No, none of my learners are enrolled in Shabbaton

I would like to add the following amount as a donation to the S. Darwin Noll Fund for Jewish Education to help other families afford Learning Center tuition:

Please fill in amount.

My preferred billing option:

Upon submitting this form, you will be redirected to a confirmation page. If you have indicated that you will pay by credit card today, you will be presented with the link to pay. Please remember the Total that is listed below.

Pay by credit card today

Add TLC fees to my Temple account

Total