B’nai Mitzvah Registration

Part 1 : Student Information

Name*

First Last

Preferred Pronoun

Please Indicate if Other

Jewish By*

Tribe

Hebrew Name

Birth Date*

Click Inside the Box to Launch Date Picker

Email*

Age

School

Grade for Registration Year

Part 2 : Parent/Guardian Information

Parents Are

If Divorce or Separated, Child Lives With

Hidden

Guardian's Name

First Last

Mother / Guardian's Name

First Last

Mother's Date of Birth

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

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?

Does your child speak/understand Hebrew?

Does your child have any learning challenges with general studies?

Additional Information

Part 4 : Medical Information (Confidential) and Consent

Is your child up to date with vaccinations*

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

This field is for validation purposes and should be left unchanged.

B’nai Mitzvah Class Registration Form