Registration for Educational Programming 2021/2022

BSI Registration

for the 5784 - 2023/2024 Year!
Dear BZ family,

I cannot wait to start the new year for Beit Sefer Ivri! The goal of our BSI is to give our students tools to be lifelong learners. Through Hebrew reading, Torah trope, Jewish text study, and a personalized approach to each student, we know each child will grow more confident in their knowledge and Jewish identity.

Looking forward to the year ahead!

Sincerely,
Rabbi Rotenberg
Student Information
BSI is open to children in K-8th grade.

Our Wednesday program will have instruction for students K-6th grade. If your child is in 7th or 8th grade, or is being tutored for their Bar/Bat Mitzvah, please register them for BSI, and we will work on a personalized tutoring schedule for them.
Student Name 1*

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

MonthDayYear
Gender*

MaleFemale
Incoming Secular School Grade*
Student Name 2

First NameLast Name
Student's Hebrew Name 2
Birth Date

MonthDayYear
Gender

MaleFemale
Incoming Secular School Grade
Student Name 3

First NameLast Name
Student's Hebrew Name 3
Birth Date

MonthDayYear
Gender

MaleFemale
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 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
Physician's Name*
Phone Number*

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

First NameLast Name
Relationship*
Cell Phone*

Area CodePhone 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 to call our physician or take our child to the hospital to receive appropriate emergency treatment.*

We AuthorizeWe 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 permissionWe 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 (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 AuthorizeWe 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.*

YesNo
Registration Cost:

For one child: $200
For each additional child: $100

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 in August!
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.

We can't wait to see you in August!