ICSS Registration

Guardian 1 Name

Guardian 1 Phone Number

* Guardian 1 Email

Guardian 1 Address Line 1

Guardian 1 Address Line 2

Guardian 2 Name

Guardian 2 Phone Number

Guardian 2 Email

Guardian 2 Address Line 1

Guardian 2 Address Line 2

* Emergency Contact Name (Not Guardian)

* Emergency Contact Phone Number

Child 1 Name

Child 1 School

Child 1 Grade (2020-2021 Year)

Please list/describe any relevant medical (including food allergies), developmental, or learning conditions concerning your child.

Child 2 Name

Child 2 School

Child 2 Grade (2020-2021 Year)

Please list/describe any relevant medical (including food allergies), developmental, or learning conditions concerning your child.

Child 3 Name

Child 3 School

Child 3 Grade (2020-2021 Year)

Please list/describe any relevant medical (including food allergies), developmental, or learning conditions concerning your child.

Child 4 Name

Child 4 School

Child 4 Grade (2020-2021 Year)

Please list/describe any relevant medical (including food allergies), developmental, or learning conditions concerning your child.

Medical Emergency I grant my authorization and consent for Temple B'nai Israel to summon professional emergency personnel to attend, transport, and treat my student and to issue consent for any medical treatment. I agree to assume financial responsibility for all expenses of such care. PLEASE SIGN

Can we take photos and videos of your child to post on Temple bulletins, newsletters and social media? YES OR NO

Number of Children in ICSS

After May 3, the cost is $275 per child. Due to COVID changes, we have reduced charges by 10%. You have the option to pay in full today or pay a deposit today ($36) and have the remainder of your bill charged in three installments on September 1, October 1, and November 1. There is further financial assistance available. Please contact Sarah Sweeney at 405.848.0965 or at tbieducator@coxinet.net for more information.

Pay ICSS In Full For One Child

Pay ICSS In Full For Two Children

Pay ICSS In Full For Three Children

Pay ICSS In Full For Four Children

Pay Deposit Today

Total ICSS Payment Due Today

Tue, January 26 2021
13 Shevat 5781

Tue, January 26 2021 13 Shevat 5781