Riverdale Temple Learning Center Application

Welcome to the 2024–25 RTLC School Year

We look forward to greeting your family on the first day of classes, Sunday, September 29, 2024 at 9:30am. In late August, a calendar and additional information will be emailed to you. Classes for all grades will meet in-person on Sundays from 9:30am to 11:30am. 4th grade and up will also meet in-person on Tuesdays from 4:00pm to 5:30pm. The first Tuesday class will be on September 17. If you have any questions about the school or the schedule, please reach out to Judith Lewis, RTLC Director at judithlewis@riverdaletemple.org.

Shalom! Riverdale Temple Learning Center welcomes you to the 2024–25 School Year!

PLEASE READ BEFORE REGISTERING: RIVERDALE TEMPLE LEARNING CENTER TUITION IS INCLUDED AS PART OF YOUR RIVERDALE TEMPLE MEMBERSHIP. IF YOU HAVE NOT YET REGISTERED FOR MEMBERSHIP, PLEASE DO SO HERE FIRST.

PARENT INFORMATION

Parent 1

* Parent 1 First Name

* Parent 1 Last Name

* Parent 1 Email Address

* Parent 1 Cell Phone

* Parent 1 Address

* Parent 1 City

* Parent 1 State

* Parent 1 Zip

* Is this your family’s first year at RTLC?

Please Select OneYesNo

If yes, how did you hear about Riverdale Temple and RTLC?

Is there another parent to fill in information for?

NoYes

Parent 2

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email Address

Parent 2 Cell Phone

Parent 2 Address (if different)

Parent 2 City

Parent 2 State

Parent 2 Zip

Emergency Name

Emergency Number

* PHOTO RELEASE FORM: From time to time, Riverdale Temple may use your child’s name, likeness, voice, statements, and other information supplied by him/her in a variety of synagogue publications, including but not limited to: Bulletin, weekly calendar, flyers, Riverdale Temple website (both photos and mini-videos without individual identification on public-facing side of the site, but with names on the password-protected site). This use relates solely to photographs, statements, and video made during your child’s participation in Riverdale Temple-sponsored activities. Please select your preference.

Please Select OneYes, I allow my child/ren’s name, likeness, voice, statements and other information supplied by my child/ren to be used by Riverdale Temple.No

If you have a teen or child aged out of the RTLC who would like to volunteer either in a classroom or office, and receive community service credit, indicate name, age, and area of interest:

CHILD INFORMATION

Total number of children to fill in information for?

123

Child 1

* Child 1 First Name

* Child 1 Last Name

* Child 1 Preferred Pronoun

HeSheThey

* Child 1 Hebrew Name

* Child 1 Birthday

* Child 1 School Name

* Child 1 Allergies, Medical Information, or Family Changes (including learning and emotional needs)

Does Child 1 have an IEP? Please elaborate.

Child 2

Child 2 First Name

Child 2 Last Name

Child 2 Preferred Pronoun

HeSheThey

Child 2 Hebrew Name

Child 2 Birthday

Child 2 School Name

Child 2 Allergies, Medical Information, or Family Changes (including learning and emotional needs)

Does Child 2 have an IEP? Please elaborate.

Child 3

Child 3 First Name

Child 3 Last Name

Child 3 Preferred Pronoun

HeSheThey

Child 3 Hebrew Name

Child 3 Birthday

Child 3 School Name

Child 3 Allergies, Medical Information, or Family Changes (including learning and emotional needs)

Does Child 3 have an IEP? Please elaborate.

VOLUNTEER and ADDITIONAL INFORMATION

* I am interested in volunteering for the following (check all that apply)

Holiday EventsClass ParentI am not interested at this timeOther

Please use this space to provide additional information you would like to share about your child/ren, family, or hopes for Riverdale Temple and the upcoming school year. All information is confidential and will not be shared without your approval.

Riverdale Temple Learning Center Application