Registration for Educational Programming 2021/2022

BSI Registration
Our Sunday BSI program will have instruction for students Pre-K to 8th grade!

If your child has a Bar/Bat mitzvah scheduled at B'nai Zion within the next two years, private one on one tutoring will be scheduled at your convenience, and costs $300/year. (scholarships available!)

If you would like to discuss having your child's Bar/Bat Mitzvah at B'nai Zion, please contact Rabbi Rotenberg!
Student Name 1

First NameLast Name
Student's Hebrew Name 1
Birth Date

MonthDayYear
Incoming Secular School Grade
Student Name 2

First NameLast Name
Student's Hebrew Name 2
Birth Date

MonthDayYear
Incoming Secular School Grade
Student Name 3

First NameLast Name
Student's Hebrew Name 3
Birth Date

MonthDayYear
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
Mailing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Parent/Guardian 2

First NameLast Name
Cell Phone

Area CodePhone Number
E-mail
If parents are not married and living in the same house, please attach custody agreement.

Browse Files

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If Parent 2 lives at a different address, please include here:
The following individuals are authorized to pick up my child(ren) from Beit Sefer Ivri. Please share Name, relationship, and phone number.
Please note that parents/guardians must notify Beit Sefer Ivri staff in advance if someone other than a parent/guardian will be picking up their child(ren). Beit Sefer Ivri may request photo identification from any authorized pick-up individual before releasing a child.
Emergency Information
Please note, in an emergency, we will call 911 and then notify parents/guardians as soon as possible. In the event we cannot reach a parent/guardian we will contact the emergency contact you list below.
If Parent or Guardian cannot be contacted:

First NameLast Name
Relationship
Cell Phone

Area CodePhone Number
Our programming recognizes the importance of ensuring the success of each student.

All information you share will be kept strictly confidential.
Does your child have any allergies? If yes, please describe: (Examples: food allergies, insect sting allergies, medication allergies, environmental allergies.) Please describe and indicate any required accomodations.
Does your child have any medical condition that may require attention during Beit Sefer Ivri activities? If yes, please describe:Examples: asthma, diabetes, seizure disorder, severe migraines, heart condition, etc.)
Does your child take any medication that may need to be administered during Beit Sefer Ivri hours or that staff should be aware of in an emergency? If yes, please describe:
Does your child carry or require any emergency medication? If yes, please describe:
Does your child have any dietary restrictions or food-related accommodations we should be aware of? If yes, please describe:
Does your child have any physical, developmental, learning, behavioral, sensory, or emotional needs that would help us support their participation and success in Beit Sefer Ivri? If yes, please describe:
Please note that BSI is not a medical, therapeutic, or special education program. We welcome information that will help us support your child safely and successfully. If your child requires accommodations, please contact us so we can discuss how we may be able to meet their needs. More information is available in the BSI Parent Handbook.
Is there anything else you would like us to know to help keep your child safe and ensure a positive experience?
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.
Parent/Guardian Acknowledgment and Agreement

Please click HERE to download and read our BSI Parent Handbook.

As a condition of enrollment and participation in Beit Sefer Ivri, I acknowledge that I have received access to the Beit Sefer Ivri Parent Handbook and agree to comply with the policies, procedures, and expectations set forth therein, as they may be amended from time to time.

I understand that the Parent Handbook is intended to help foster a safe, respectful, and supportive learning environment for all students and families, and I agree to support my child in complying with its expectations.

I certify that the information provided in this registration form is true and complete to the best of my knowledge.
Registration Costs:

$350 per child

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

BSI Registration

Parent/Guardian Information

Emergency Information

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

Photograph/Video Release

We can't wait to see you soon!