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B’nai Mitzvah Registration
Home
Education and Programs
Children, Youth and Families
B’nai Mitzvah Registration
B’nai Mitzvah Class Registration Form
Part 1 : Student Information
Name
*
First
Last
Preferred Pronoun
she/her
he/him
they/them
I prefer not to say
Other
Please Indicate if Other
Jewish By
*
Birth
Conversion
Not Jewish
Tribe
Cohen
Levite
Israelite
Hebrew Name
Birth Date
*
MM slash DD slash YYYY
Click Inside the Box to Launch Date Picker
Email
*
Age
School
Grade for Registration Year
Part 2 : Parent/Guardian Information
Parents Are
Single
Married
Divorced
Widowed
Separated
If Divorce or Separated, Child Lives With
Both (Joint Custody)
Mother
Father
Guardian
Hidden
Guardian's Name
First
Last
Mother / Guardian's Name
First
Last
Mother's Date of Birth
MM slash DD slash YYYY
Click on the Box to launch Date Picker
Mother's Address
Street Address
City
Province
Postal Code
Mother's Home Phone
Mother's Cell Phone
Mother's Business Phone
Mother's Email
I would like to receive B’nai Mitzvah Class updates, notifications and communication.
*
Yes
No
I would like to receive all other Congregational communications such as: Shalom Byte, Shofar and Memorial notices.
*
Yes
No
Father / Guardian's Name
First
Last
Father's Date of Birth
MM slash DD slash YYYY
Click on the Box to launch Date Picker
Father's Address
Street Address
City
Province
Postal Code
Father's Home Phone
Father's Cell Phone
Father's Business Phone
Father's Email
I would like to receive B’nai Mitzvah Class updates, notifications and communication.
*
Yes
No
I would like to receive all other Congregational communications such as: Shalom Byte, Shofar and Memorial notices.
*
Yes
No
Part 3 : Hebrew Education
Does your child read Hebrew?
Yes
No
Somewhat
Does your child speak/understand Hebrew?
Yes
No
Somewhat
Does your child have any learning challenges with general studies?
Yes ( Please Provide Additional Information Below)
No
Additional Information
Part 4 : Medical Information (Confidential) and Consent
Is your child up to date with vaccinations
*
Yes
No
Are there any medical concerns (i.e. allergies) or additional information regarding your child that we should be aware of?
Please Check for Consent
*
I hereby consent to the Beth Tzedec School Administration to take necessary medical measures for my child in the event of any medical emergency.
Part 5 : Emergency Contact Person to be contacted in case of an emergency (when parent/guardian cannot be reached):
Name of Emergency Contact (other than parent)
*
First
Last
(when parents cannot be contacted)
Relationship to the Child
Phone
Cell Phone
Part 6: Media Consent
On the Beth Tzedec website
*
Yes
No
On the Beth Tzedec Facebook page
*
Yes
No
In Beth Tzedec newsletters or publications
*
Yes
No
In external newsletters or publications (ie. Jewish Free Press)
*
Yes
No
Please Check
I understand that no personal information, such as names, will be used in any publications unless express consent is given. I further understand that this consent may be withdrawn by me at any time, upon written notice.
Part 7: Shared Information Consent
Please Check
*
I hereby grant the Beth Tzedec permission to share our contact information, with fellow families of the B’nai Mitzvah Class, for the purpose of invitations to birthday &/or B’nai Mitzvah celebrations or other social gatherings.
Part 8 : Tuition and Payment $500.00 per year / student Books and Materials are included in Tuition. (May not include dinners, outings or retreats). Families MUST be members in good standing at time of registration. Families are encouraged to contact Interim CEO, David Inhaber at
403-255-8688
, ext. 1, or
ceo@bethtzedec.ca
to make an appointment to discuss, in confidence, payment arrangements for the B’nai Mitzvah Program and/or Membership with Beth Tzedec Congregation.
Tuition
Price:
Method of Payment
Cash
Cheque (payable to Beth Tzedec Congregation)
Credit Card: Visa / MasterCard / American Express
CAPTCHA
Total
$ 0.00 CAD
Name
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