Registration for Educational Programming 2021/2022

BSI and Kadima Registration
BSI Registration is closed for 2025-2026 year, keep an eye out for 2026-2027 registreation.
Student Name 1*

First NameLast Name
Student's Hebrew Name 1
Birth Date*

MonthDayYear
Incoming Secular School Grade*
Check this box to register this child for Kadima (grades 5-8):

Can't wait!
Student Name 2

First NameLast Name
Student's Hebrew Name 2
Birth Date

MonthDayYear
Incoming Secular School Grade
Check this box to register this child for Kadima (grades 5-8):

Can't wait!
Student Name 3

First NameLast Name
Student's Hebrew Name 3
Birth Date

MonthDayYear
Incoming Secular School Grade
Check this box to register this child for Kadima (grades 5-8):

Can't wait!
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 NameLast Name
Cell Phone*

Area CodePhone Number
E-mail*
Parent/Guardian 2

First NameLast Name
Cell Phone

Area CodePhone Number
E-mail
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Please list other people and their relationship to your child who are authorized to pick them up from Beit Sefer Ivri:
Emergency Information
If Parent or Guardian cannot be contacted:*

First NameLast Name
Relationship*
Cell Phone*

Area CodePhone Number
Does your child have any medical concerns (medications, inhalers, epi pens, etc.)? Please be specific.*
Does your child have any allergies? Please be specific.*
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 permissionWe DO NOT give permission
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.*

YesNo
Registration Costs:

BSI:

For one child: $325
For each additional child: $250

Kadima:

$180 $90 per child

Due to a generous donation to our Kadima fund from Helen Pregulman's children in honor of her 97th birthday, we are able to decrease our Kadima registration fee for this year.

If your family needs assistance, please contact Rabbi Rotenberg. No child will be turned away!
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.
We can't wait to see you soon!
Should be Empty:

BSI and Kadima Registration

Parent/Guardian Information

Emergency Information

Photograph/Video Release

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

We can't wait to see you soon!