Arts and Sports Program: Ulpan 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

Please choose which ULPAN Program you wish to attend.*

ULPAN Showcase
ULPAN Sports
Please contact me, I need more information

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 ULPAN updates, notifications and communication*

Yes
No

I would like to receive all other Congregational communications such as: Shalom Byte, Shofar and Program Information*

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 ULPAN updates, notifications and communication*

Yes
No

I would like to receive all other Congregational communications such as: Shalom Byte, Shofar and Program Information*

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 and Instagram page*

Yes
No

In Beth Tzedec newsletters or publications*

Yes
No

In external newsletters or publications (ie. Alberta Jewish News)*

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 Beth Tzedec permission to share our contact information, with fellow families of the UPLAN Program, for the purpose of invitations to birthday &/or Shul School celebrations or other social gatherings.

Part 8 : Tuition and Payment $360.00 per year/BTZ Congregants and $720.00 per year/for Guest Families. (May not include dinners, outings or retreats). Please contact our office if you would like to use a payment plan.

Fee

Method of Payment

Cash
Cheque (payable to Beth Tzedec Congregation)
Credit Card: Visa / MasterCard / American Express
Payment Plan (contact the office)
Paypal

Total

$ 0.00 CAD

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