Beth El Religious School and Hebrew High School Registration and Emergency Form 2021-2022/5782

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In order to facilitate planning for the upcoming school year, please submit this registration form. The registration form should be submitted on or before June 1, 2021 and must be accompanied by a $25.00 per student registration fee. Registration forms received after June 1, 2021 require a $40.00 per student registration fee. Registration fees up to $25 will be applied towards tuition. Payment instructions are provided at the end of this form.

Students

Name of Student *

Hebrew Name of Student? (If known)

Birthdate of Student? *

YYYY

Hebrew Birthdate of Student? (If Known)

Secular Grade of Student entering in the Fall? *

Hebrew Grade entering in the Fall? *

Please list all allergies, including environmental, food, and/ or medicine. *

Please list any medical conditions (This will be kept confidential, and is only used for emergency purposes.) *

Please list all prescription medications (name only). If there is a history of anaphylaxis, please indicate whether the student carries an EpiPen or equivalent. *

Please list any special learning needs and/or disabilities so that we can make proper accommodations. *

Please list any personal interests, hobbies, or talents. *

At the present time, do you anticipate that your child will attend the beginning of the 2021 religious school year hybrid or virtual? *

Hybrid

Virtual

Not yet sure

Would you like to add another student? *

Yes

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