Religious School Registration 2023 - Form - Beth David Reform Congregation

Shalom! Thank you for registering your child(ren) for Religious School this coming year!!

Please share the following information with us, so that we can plan for a successful year for all members of our learning community.

Registration is due by September 15; any registration after that date, for returning families, may be charged a late fee.

All families will be billed on their account for their school registration.

* Student #1 First Name

* Student #1 Last Name

What does your child like to be called?

What pronouns does your child use?

* Date of Birth

Email Address for Student

Cell phone for Student

Secular/Day School Name

Does your child have:

IEP504 PlanOther needs

Comments: What else do we need to know about their needs?

We will follow up before the school year begins

Does your child have any allergies?

FoodsMedicationsBee stings or insect bitesOther

Comments

If you checked any allergies, please give us details: Epi-pen information; if the allergy is inhaled, ingested or from contact; specific medication allergy. This information is extremely important in the event of an emergency, and so that we can avoid allergens for your student.

Epi-Pen

YesNo

If yes, does your child carry the epi-pen or would you like us to keep it in the office or with the teacher?

What medications does your child take regularly?

Please be specific as this could be important in the event of an emergency.

What medications does your child carry with them?

Some examples would be: Epi-pen, insulin, inhaler, benedryl, etc.

What are your child's favorite activities?

Is there anything else that would be helpful for us to know about your child?

Please scroll down to Family Information if you are not registering any more children.

Student #2 First Name

Student #2 Last Name

What does your child like to be called?

What pronouns does our child use?

Date of Birth

Email Address for Student

Cell phone for Student

Secular/Day School Name

Does your child have:

IEP504 PlanOther needs

Comments: What else do we need to know about their needs?

We will follow up before the school year begins

Does your child have any allergies?

FoodsMedicationsBee stings or insect bitesOther

Comments

Epi-Pen

YesNo

If yes, does your child carry the epi-pen or would you like us to keep it in the office or with the teacher?

What medications does your child carry with them?

Some examples would be: Epi-pen, insulin, inhaler, benedryl, etc.

What medications does your child take regularly?

Please be specific as this could be important in the event of an emergency.

What are your child's favorite activities?

What are some of your child's favorite snacks?

Is there anything else we should know about your child?

Please scroll down to Family Information if you are not registering any more children.

Student #3 First Name

Student #3 Last name

What does your child like to be called?

What pronouns does our child use?

Date of Birth

Email Address for Student

Cell phone for Student

Secular/Day School Name

Does your child have:

IEP504 PlanOther needs

Comments: What else do we need to know about their needs?

Does your child have any allergies

FoodsMedicationsBee stings or insect bitesOther

Comments

Epi-Pen

YesNo

If yes, does your child carry the epi-pen or would you like us to keep it in the office or with the teacher?

What medications does your child take regularly?

Please be specific as this could be important in the event of an emergency.

What medications does your child carry with them?

Some examples would be: Epi-pen, insulin, inhaler, benedryl, etc.

What are your child's favorite activities?

What are some of your child's favorite snacks?

Is there anything else we should know about your child?

If you have additional students to register, please email Rabbi Koppel at EKoppel@bdavid.org

FAMILY INFORMATION

* Parent/Guardian #1 First Name

* Parent/Guardian #1 Last Name

Relationship to Student(s)

Home Phone

Cell Phone

* Email Address

Parent/Guardian #2 First Name

Parent/Guardian #2 Last Name

Relationship to student(s)

Home Phone

Cell Phone

Email Address

Parent/Guardian #3 First Name

Parent/Guardian #3 Last Name

Relationship to students(s)

Home Phone

Cell Phone

Email Address

Parent/Guardian #4 First Name

Parent/Guardian #4 Last Name

Relationship to student(s)

Home Phone

Cell Phone

Email Address

Who else is in your immediate family?

* Who may pick up your student(s)? Please give full names and cell numbers (other than those listed above). If no one else may pick them up, type "no one"

* EMERGENCY CONTACTS: Please give us 2 people (other than you or those listed above) that we may contact in the event that we cannot reach you. Please list their names and contact phone numbers.

I hereby give Beth David staff permission to take whatever emergency health measures as they deem necessary for the health and safety of my child or others.

* I agree

I agree

I give permission for my child to attend field trips during Religious School.

* I agree

I agree

My child may be given the following over-the-counter medications (such as headache relief medicine, cough drops, antihistamine, etc.) We will contact you or your designated emergency contact before giving any medication or treatment, except in the case of any emergency.

Please check all that apply (if none, do not check any box)

Please list any other over-the-counter medications your child may take that are not listed.

PHOTO PERMISSION

From time to time we take pictures during school. We would like your permission to use these pictures. We will never reference your child by name or provide any specific information regarding your child. We also will never sell these pictures; we will use them exclusively for internal purposes and promotional activities (including, but not limited to our website, Facebook page, flyers, and brochures).

We will always ask before using your child's image if we are using the image for any other purpose.

* Do you give us permission?

Please Select OneYes, I give permissionNo, I do not give permission

Any other, or more specific, permissions or restrictions for use of your child(ren)'s image?

Please sign below indicating that all information provided is current and accurate to the best of your knowledge.

* Electronic Signature

Please type your full name.

* I understand that checking this constitutes a legal signature

I understand that checking this constitutes a legal signature

Thank you for registering your family for Religious School!!! We'll be in touch soon with more details about the year.