Religious School 2023

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NOTICE:
If you are paying:

in multiple payments (ie, monthly)
with a method other than CC or EFT on file (ie, check)

You MUST be logged into the website. Do not fill out this form until you are logged in.

Family Information

Parent First Name

Parent Last Name

* Email

Cell Phone Number

Home Phone Number

Work Phone Number

Address

Address Line 2

City

ZIP

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Mobile

Parent 2 Work Phone

Does Parent 2 have a different address?

NoYes

Parent 2 address

Parent 2 City

Parent 2 State

Parent 2 Zip

Emergency Contacts

Emergency Contact 1

Emergency Contact 1 Phone

Relation to Emergency Contact 1

Emergency Contact 2

Emergency Contact 2 Phone

Relation to Emergency Contact 2

Medical Data

Physician Name

Physician Phone Number

Dentist Name

Dentist Phone Number

Student Information

Click the "+" to add a student.

Student Information

First Name

Last Name

Hebrew Name

Birthdate

Age

Grade in Sept 2023

Registering for...

GAN (preschool: $180)Religious School, K-7th grade ($800)Religious School, K-7th grade (sibling: $700)Please select the $800 option for your first child, and then the $700 option for each additional child.

Books and Supplies Fee

GAN Snack ($18)Religious School Books & Supplies ($40)The books and supplies fee is mandatory. Please select the correct one for your program.

Allergies

Medications

Emergency Release

In the event of an emergency, I hereby give permission to Congregation Beth Evergreen or its agent to hospitalize and/or secure proper treatment for my child as named in this registration form.

Field Trip Release

I authorize my child (listed above) to leave Beth Evergreen for Field Trips with adequate supervision and advanced notice.

Photo and/or Video Release Authorization Form

Photos and/or videos will be taken of students, student activities, etc. I authorize the use of photos and videos of my child (listed above) for news releases, the synagogue website, facebook, school-related video and slide presentations, marketing purposes, Shofar, Newsletter etc.

Digital Signature

Today's Date

If you are paying: