Beth Israel Hebrew School 2021-2022

Registration Form For Beth Israel Hebrew School
2021/2022 - 5782
Gesher Club (ages 3 & 4) - Grade 7

* How many children are you registering for Religious School?

Please Select OneOneTwoThreeIf you are registering more than 3 children, please call Beth Israel's Office at 604-731-4161 or email Rabbi Bluman at rabbidavidbluman@bethisrael.ca

First Child:

* Name of First Child

* First Child - Date of Birth

* What day school does your child attend?

* First child - Please enter your child's Hebrew name (if known):

* First Child - What grade is your child entering in September 2021?

Consent:

* Contact Information:

Please Select OneYes, I do hereby consent and agree with the statement below with regard to sharing contact informationNo, I do not consent and agree to the sharing of contact informationI give Beth Israel Hebrew School consent to publish my contact information ( Name, Phone, and Address) in a Hebrew School Phone Book. The Phone Book will solely be distributed to Hebrew School Families.

* Promotional Material:

Please Select OneYes, I do hereby consent and agree with the statement below.No, I do NOT consent.

I give Beth Israel Hebrew School consent to use pictures and videos of my child in its promotional material (newsletters, email blasts, website, advertisements, etc.). I also understand that my child's name or contact information will not be published with their picture.

* Field Trips:

Please Select OneYes, I give permission for my child to participate in all activitiesNo, I do not consentI give permission for my child to participate fully in all activities of the Beth Israel Hebrew School for the 2021/2022 school year. I understand that field trips will be adequately supervised, and transportation will be arranged either by parent carpools, school buses, or walking, and that I will be informed beforehand of all such trips.

* Parent/Legal Guardian Name:

Please enter the name of the parent or legal guardian who completed the consent section of the form.

Consent for Emergency Medical Treatment

* I hereby give consent for my child, if needed to be provided with medical treatment by Rabbi Bluman or his designee or be taken to the nearest emergency center by Rabbi David Bluman or his designee.

Please Select OneI give consentI do NOT give consent

It is Beth Israel Hebrew School's policy to notify a parent when a child is ill or needs medical attention. If immediate help for the child is required and a parent cannot be contacted the procedure is to take the child to the nearest emergency service.

* Parent/Legal Guardian Name:

Please enter the name of the parent or legal guardian who completed the consent for medical treatment.

Parent/Guardian Information for the first child:

* Parent/Guardian 1: First Name

* Parent/Guardian 1: Last Name

* Street Address of Parent/Guardian 1

* Email address for Parent/Guardian 1:

* Primary phone for Parent/Guardian 1:

Alternative phone for Parent/Guardian 1:

Parent/Guardian 2: First Name

Parent/Guardian 2: Last Name

Street Address of Parent/Guardian 2

Email address for Parent/Guardian 2:

Primary phone for Parent/Guardian 2:

Alternative phone for Parent/Guardian 2:

Additional Information about the first child:

* Does this child have an IEP or other academic plan in place in their secular school?

Please Select OneYesNo

If yes, please provide information on your child's academic plan:

* Is there anything we need to know or be sensitive to concerning the emotional or behavioral well-being of this child?

Please Select OneYesNo

If yes, please provide information on your child's emotional or behavioral well-being.

* Does this child have any food allergies?

Please Select OneYesNo

If yes, please provide specific information on your child's food allergies:

* Does this child have any other health concerns that could affect them at Hebrew School?

Please Select OneYesNo

If yes, please provide specific information on your child's health concerns.

Please share any other information that will help us create a safe, effective, and meaningful educational experience for your child:

Emergency Contact Information for the first child:

* First Child - Name of child's Primary Physician

* First Child - Phone number of child's Primary Physician

* First Child - Emergency Contact 1

Please enter the name of an emergency contact who is not a Parent/Guardian of the child.

* First Child - Relationship to Emergency Contact 1

For example: Aunt, Uncle, Cousin, or friend

* First Child - Emergency Contact 1 Phone Number

First Child - Emergency Contact 2

Please enter the name of an emergency contact who is not a Parent/Guardian of the child.

First Child - Relationship to Emergency Contact 2

For example: Aunt, Uncle, Cousin, or friend

First Child - Emergency Contact 2 Phone Number

Registration and Payment Policy

Every student, including returning students, must be registered and have their fees paid before the first day of class. Registration forms will only be processed with the $150 non-refundable deposit.

School Refund Policy

Fees are non refundable after the 4th week of classes. Partial Refunds are available prior to the 4th week of classes.

Membership at Beth Israel

Please be aware that Congregation Beth Israel provides for the celebration of Bar/Bat Mitzvahs for Members only. We welcome your membership inquiries by contacting the office at (604) 731-4161.

Tuition Fees (includes non-refundable $150 deposit)

* Membership at Congregation Beth Israel is required for families with students in Grades 5 and up.

An activity fee of $75 is required in addition to tuition fees listed below.

For BI Members:

$550.00 Gesher Club (ages 3-4)

$550.00 Kindergarten, Grades 1 & 2

$1,040.00 Grades 3 & 4

$1,040.00 Grades 5 & 6

$1,635.00 Grade 7 (includes Tn'T)

For non-Members:

$795.00 Gesher Club (ages 3-4)

$795.00 Kindergarten, Grades 1 & 2

$2,010.00 Grades 3 & 4

N/A Grades 5 & 6

N/A Grade 7 (includes Tn'T)

Those who pay in full will receive a 5% discount.

Tuition Payment for First Child

* A NON REFUNDABLE DEPOSIT OF $150.00 IS REQUIRED. PLEASE CHOOSE ONE OF THE FOLLOWING METHODS OF PAYMENT:

Notes:

If four monthly payments are selected, please call the Beth Israel Office with your credit card information or submit a void cheque to the BI Office.
If you have indicated that you would like to discuss financial assistance, please call the Beth Israel Office to setup an appointment to speak with Esther Moses-Wood, Executive Director

Second Child:

Second Child - Name

Second child - Date of Birth

* Second child - What day school does your child attend?

Second child - Please enter your child's Hebrew name (if known):

Second Child - What grade is your child entering in September 2021?

Consent:

Contact Information:

Promotional Material:

Yes, I do hereby consent and agree with the statement below.No, I do NOT consent.I give Beth Israel Hebrew School consent to use pictures and videos of my child in its promotional material (newsletters, email blasts, website, advertisements, etc.). I also understand that my child's name or contact information will not be published with their picture.

Field Trips:

Yes, I give permission for my child to participate in all activities.No, I do NOT consentI give permission for my child to participate fully in all activities of the Beth Israel Hebrew School for the 2021/2022 school year. I understand that field trips will be adequately supervised, and transportation will be arranged either by parent carpools, school buses, or walking, and that I will be informed beforehand of all such trips.

Parent/Legal Guardian Name:

Please enter the name of the parent or legal guardian who completed the consent section of the form.

Consent for Emergency Medical Treatment:

I hereby give consent for my child, if needed to be provided with medical treatment by Rabbi Bluman or his designee or be taken to the nearest emergency center by Rabbi David Bluman or his designee.

I give consentI do NOT give consent

Parent/Legal Guardian Name:

Please enter the name of the parent or legal guardian who completed the consent for medical treatment for the 2nd child.

Parent/Guardian Information for the second child:

* Are the Parents/Guardians of the second child the same as for the first child?

Please Select OneYesNo

* Second Child - Parent/Guardian 1: First Name

* Second Child - Parent/Guardian 1: Last Name

* Second Child - Street Address of Parent/Guardian 1

Second Child - Email address for Parent/Guardian 1:

Second Child - Alternative phone for Parent/Guardian 1:

Second Child - Parent/Guardian 2: First Name

Second Child - Parent/Guardian 2: Last Name

Second Child - Street Address of Parent/Guardian 2

Second Child - Email address for Parent/Guardian 2:

Second Child - Primary phone for Parent/Guardian 2:

Second Child - Alternative phone for Parent/Guardian 2:

Additional Information about the second child:

* Does your 2nd child have an IEP or other academic plan in place in their secular school?

Please Select OneYesNo

If yes, please provide information on your 2nd child's academic plan:

* Is there anything we need to know or be sensitive to concerning the emotional or behavioral well-being of this child?

Please Select OneYesNo

If yes, please provide information on your 2nd child's emotional or behavioral well-being.

* Does your 2nd child have any food allergies?

Please Select OneYesNo

If yes, please provide specific information on your 2nd child's food allergies:

* Does your 2nd child have any other health concerns that could affect them at Hebrew School?

Please Select OneYesNo

If yes, please provide specific information on your 2nd child's health concerns.

Please share any other information that will help us create a safe, effective, and meaningful educational experience for your 2nd child:

Emergency Contact Information for the second child:

* Is ALL of the Emergency Contact information for the second child the same as for the first child?

Please Select OneYesNoThis includes: Primary Physician and 2 non-parent/guardian emergency contacts.

Second Child - Name of child's Primary Physician

Second Child - Phone number of child's Primary Physician

Second Child - Emergency Contact 1

Please enter the name of an emergency contact who is not a Parent/Guardian of the child.

Second Child - Relationship to Emergency Contact 1

For example: Aunt, Uncle, Cousin, or friend

Second Child - Emergency Contact 1 Phone Number

Second Child - Emergency Contact 2

Please enter the name of an emergency contact who is not a Parent/Guardian of the child.

Second Child - Relationship to Emergency Contact 2

For example: Aunt, Uncle, Cousin, or friend

Second Child - Emergency Contact 2 Phone Number

Tuition Payment for Child 2:

* A NON REFUNDABLE DEPOSIT OF $150.00 IS REQUIRED. PLEASE CHOOSE ONE OF THE FOLLOWING METHODS OF PAYMENT:

Notes:

If four monthly payments are selected, please call the Beth Israel Office with your credit card information or submit a void cheque to the BI Office.
If you have indicated that you would like to discuss financial assistance, please call the Beth Israel Office to setup an appointment to speak with Esther Moses-Wood, Executive Director

Third Child:

Third Child - Name

Third Child - Date of Birth

* Third child - What day school does your child attend?

Third Child - Please enter your child's Hebrew name (if known):

Second Child - What grade is your child entering in September 2021?

Consent:

Contact Information:

Yes, I do hereby consent and agree with the statement below with regard to sharing contact informationNo, I do not consent and agree to the sharing of contact information

I give Beth Israel Hebrew School consent to publish my contact information ( Name, Phone, and Address) in a Hebrew School Phone Book. The Phone Book will solely be distributed to Hebrew School Families.

Promotional Material:

Yes, I do hereby consent and agree with the statement below.No, I do NOT give consent.

Promotional Material

Yes, I do hereby consent and agree with the statement below and allow the use of images of myself or my child in the media.No, I do not consent to the use of images of myself or my child in the media.

Field Trips:

Yes, I give permission for my child to participate in all activitiesNo, I do not consent

I give permission for my child to participate fully in all activities of the Beth Israel Hebrew School for the 2021/2022 school year. I understand that field trips will be adequately supervised, and transportation will be arranged either by parent carpools, school buses, or walking, and that I will be informed beforehand of all such trips.

Parent/Legal Guardian Name:

Please enter the name of the parent or legal guardian who completed the consent section of the form.

Consent for Emergency Medical Treatment:

I hereby give consent for my child, if needed to be provided with medical treatment by Rabbi Bluman or his designee or be taken to the nearest emergency center by Rabbi David Bluman or his designee.

Yes, I give permission for my child to participate in all activitiesNo, I do not consent

Parent/Legal Guardian Name:

Please enter the name of the parent or legal guardian who completed the consent for medical treatment.

Parent/Guardian Information for the third child:

* Are the Parents/Guardians of the third child the same as for the first or second child?

Please Select OneYesNo

* Third Child - Parent/Guardian 1: First Name

* Third Child - Parent/Guardian 1: Last Name

* Third Child - Street Address of Parent/Guardian 1

Third Child - Email address for Parent/Guardian 1:

Third Child - Primary phone for Parent/Guardian 1:

Third Child - Alternative phone for Parent/Guardian 1:

Third Child - Parent/Guardian 2: First Name

Third Child - Parent/Guardian 2: Last Name

Third Child - Street Address of Parent/Guardian 2

Third Child - Email address for Parent/Guardian 2:

Third Child -Primary phone for Parent/Guardian 2:

Third Child - Alternative phone for Parent/Guardian 2:

Additional Information about the third child:

* Does your 3rd child have an IEP or other academic plan in place in their secular school?

Please Select OneYesNo

* If yes, please provide information on your 3rd child's academic plan:

* Is there anything we need to know or be sensitive to concerning the emotional or behavioral well-being of this child?

Please Select OneYesNo

If yes, please provide information on your 3rd child's emotional or behavioral well-being.

* Does your 3rd child have any food allergies?

Please Select OneYesNo

If yes, please provide specific information on your 3rd child's food allergies:

* Does your 3rd child have any other health concerns that could affect them at Hebrew School?

Please Select OneYesNo

If yes, please provide specific information on your 3rd child's health concerns.

Please share any other information that will help us create a safe, effective, and meaningful educational experience for your 3rd child:

Emergency Contact Information for the third child:

* Is ALL of the Emergency Contact information for the third child the same as for the first or second child?

Please Select OneYesNoOnly choose "Yes" if ALL of the information (Primary Physician and both Emergency Contacts) are exactly the same.

Third Child - Name of child's Primary Physician

Third Child - Phone number of child's Primary Physician

Third Child - Emergency Contact 1

Please enter the name of an emergency contact who is not a Parent/Guardian of the child.

Third Child - Relationship to Emergency Contact 1

For example: Aunt, Uncle, Cousin, or friend

Third Child - Emergency Contact 1 Phone Number

Third Child - Emergency Contact 2

Please enter the name of an emergency contact who is not a Parent/Guardian of the child.

Third Child - Relationship to Emergency Contact 2

For example: Aunt, Uncle, Cousin, or friend

Third Child - Emergency Contact 2 Phone Number

Tuition Payment for Child Three

* A NON REFUNDABLE DEPOSIT OF $150.00 IS REQUIRED. PLEASE CHOOSE ONE OF THE FOLLOWING METHODS OF PAYMENT:

Notes:

If four monthly payments are selected, please call the Beth Israel Office with your credit card information or submit a void cheque to the BI Office.
If you have indicated that you would like to discuss financial assistance, please call the Beth Israel Office to setup an appointment to speak with Esther Moses-Wood, Executive Director

Total Tuition for all children:

The above amount is the total tuition amount for Beth Israel Hebrew School

I will pay my tuition as follows:

I will pay by credit - card please charge the card linked to my Shulcloud accountPlease set up scheduled payments in 4 equal installments ending December 2021I will pay by check and will send a check to the office.I would like to discuss financial assistance for the tuition fess.

Let us know what method you will use to pay your tuition. Finances never stand in the way of your child's Hebrew School Education.

Mon, November 29 2021 25 Kislev 5782