Registration for Educational Programming 2021/2022

BSI Registration

for the 5783 - 2022/2023 Year!
Dear BZ family,

I cannot wait to start the new year for Beit Sefer Ivri! Our program will focus on Hebrew reading and speaking, and Jewish holidays and values, all within the context of building community and Jewish pride. I know that as challenging as an after school program can be, it is invaluable to building a strong Jewish identity. Thank you for entrusting us with this holy task.

Looking forward to the year ahead!

Sincerely,
Rabbi Rotenberg
Student Information
BSI is open to all incoming Kindergarteners through 8th grade of BZ members in good standing. If your child is not in Kindergarten yet, but you would like to set up individual Hebrew tutoring, please contact Rabbi Rotenberg.
Student Name 1

First Name Last Name
Student's Hebrew Name 1
Birth Date

Month Day Year
Gender

Male Female
Incoming Secular School Grade
Student Name 2

First Name Last Name
Student's Hebrew Name 2
Birth Date

Month Day Year
Gender

Male Female
Incoming Secular School Grade
Student Name 3

First Name Last Name
Student's Hebrew Name 3
Birth Date

Month Day Year
Gender

Male Female
Incoming Secular School Grade
Parent/Guardian Information
If there are any changes in address, phone number, or in who has authorization to pick up your child from educational programming throughout the course of the year, please contact Rabbi Rotenberg at rabbi@bzcongregation.com.
Parent/Guardian 1 *

First Name Last Name
Cell Phone *

Area Code Phone Number
E-mail *
Parent/Guardian 2

First Name Last Name
Cell Phone

Area Code Phone Number
E-mail
Mailing Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Please list other people and their relationship to your child that are authorized to pick them up from Beit Sefer Ivri:
Emergency Information
Physician's Name *
Phone Number *

Area Code Phone Number
Insurance Carrier *
Policy # *
If Parent or Guardian cannot be contacted: *

First Name Last Name
Relationship *
Cell Phone *

Area Code Phone Number
Does your child have any medical concerns (medications, etc.)? Please be specific.
Does your child have any allergies? Please be specific.
Emergency Medical Treatment
In case of emergency, we hereby authorize (by our indication below) the staff of B'nai Zion or Machanooga to call our physician or take our child to the hospital to receive appropriate emergency treatment. *

We Authorize We DO NOT Authorize
Photograph/Video Release
I hereby give permission to use the photograph/video of the minor(s) named above for publicity, promotion, news release, videos and web use of our school and our congregations. This also applies to the written composition or visual art of the minor if it is published. *

We give permission We DO NOT give permission
Field Trip
I hereby authorize my child to participate in field trips and programs with his/her class. I agree to hold our congregations and Machanooga (including their boards, officers, staff and volunteers) harmless from any and all claims that may arise out of his/her participation in school trips and programs. Note: Parents will receive advance notice about field trips held throughout the year. *

We Authorize We DO NOT Authorize
Our programming recognizes the importance of ensuring the success of each student.

All information you share will be kept strictly confidential.
If your child has been identified as benefiting from special needs attention (an IEP, ADD/ADHD, speech and language, developmental delays, etc.), please indicate below. Someone will reach out to you to discuss how we can best serve your child's needs. *

Yes No
If you also register for machanooga:

Per Student: $72

If registering for BSI only

For one child: $200
For two or more children: $350
I am registering my child for: *

Beit Sefer Ivri (Wednesday Hebrew School) only (K-8) Both Machanooga and Beit Sefer Ivri
Payment Method *

I will call the office with a credit card. I am sending a check in the mail. I am interested in a payment plan.
Once you have completed this form, please click on the submit button below.
We can't wait to see you at BSI!
Thank you!
Should be Empty:

BSI Registration

Student Information

Parent/Guardian Information

Emergency Information

Emergency Medical Treatment

Photograph/Video Release

Field Trip

Our programming recognizes the importance of ensuring the success of each student.

Once you have completed this form, please click on the submit button below.

We can't wait to see you at BSI!

Thank you!