BZBI Youth & Family Programs Open Registration 2023-2024

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A Message from the Youth and Family Education Department

We are thrilled that you and your child(ren) will be part of the Youth and Family Education community at BZBI!

The Youth and Family Education umbrella includes BZBI's Neziner Hebrew School (pre-K through high school), youth groups (Kadima for 5th-7th graders and USY for 8th grade-high school), Moving Traditions groups for teens, and additional programs and events throughout the year for children of all ages and their families. Through opportunities to have fun, learn, and celebrate together, we strive to create a vibrant space for our children and their families to build nourishing relationships with their peers, our synagogue community, the wider Jewish Community, and our tradition.

We, together with the Youth and Family Education Committee, are already planning as we look ahead to a 2023-2024 programming year full of opportunities to connect, celebrate, explore, and have fun. We hope you will join us and get involved by attending family events and celebrations with your children, volunteering with our Youth and Family Education Committee, or helping out with one of our many events or fundraisers during the year.

If you have any questions, please feel free to reach out to Stacey Lasky for Neziner Hebrew School questions (education@bzbi.org) or Larry Kaplan for Teen Programming questions (teens@bzbi.org). We are happy to help, and cannot wait to see you at BZBI!

L’Shalom,
Stacey and Larry

Before completing the form, please note the following:

- Progress cannot be saved, so please leave enough time to complete and submit the
entire form

- Payment information is due upon completion of this form. The form cannot be
successfully submitted without payment information

- Three payment options: If you are logged into your ShulCloud account you can...

(1) Pay by credit card online (there is a 3.5% credit card fee)
(2) Pay by e-check online (there is a 1.5% fee to pay by e-check)
(3) "Bill to my Account." If you select this option the synagogue will generate an
  invoice and add it to your account. Please note: (1) Selecting this option
  constitutes an agreement to pay the invoiced amount by or before Tuesday,
  August 15, 2023. (2) This option is only available to synagogue members.

- Tuition Refunds: We hire staff, purchase supplies, and make other important
decisions based on our enrollment numbers. For that reason, if a family chooses to
unenroll a student...

*Before June 15, 2023: we will refund 70% of tuition and fees
*Before July 15, 2023: we will refund 50% of tuition and fees
*Before August 15, 2023: we will refund 25% of tuition and fees

*On or after August 15, 2023: no refunds will be issued

- Hebrew School Tuition for a Child Only Attending Once/Week

*If NOT also enrolled in another Jewish Education program, tuition is prorated by
33% (There is no proration for Bonim or Gan as these programs only meet once
a week by design).

*If the child attends Hebrew School once a week AND is also enrolled in another
Jewish Education program of similar or greater intensity as Neziner Hebrew
School, tuition is prorated by 50%.

*STOP STOP STOP: If your child is in 1st - 7th grade and will only attend Hebrew School once per week, contact the Director (education@bzbi.org) for an alternate version of this form. If you have more than one child in 1st - 7th grade enrolling in Hebrew School, and one will attend twice a week but the other will only attend once a week, you will need to complete two forms (this form and the alternate form).

Parent / Guardian Information

* First Name of Primary Guardian

* Last Name of Primary Guardian

If there is more than one parent/guardian in your household, please make this first contact the adult who will serve as the primary point of contact should the synagogue need to reach you. Up to three additional points of contact can be added.

Occupation

* Street Address (Line 1)

Street Address, Line 2

* City

* State

* ZIP Code

* Email Address

* Mobile Phone

Please Check the Statements that Apply

I would like to get involved as a class Parent Ambassador or am interested in volunteering

Do you want to add a second parent / guardian?

YesNo

* First Name

* Last Name

Occupation

* Street Address (Line 1)

Street Address, Line 2

* City

* State

* ZIP Code

* Email Address

* Mobile Phone

Please Check the Statements that Apply

I would like to get involved as a class Parent Ambassador or am interested in volunteering

Are there custody or payment arrangements BZBI needs to be aware of?

YesNo

Please explain

PERMISSIONS

Check all that apply: I give permission for my child(ren) to...

Participate in supervised walks around the synagogue and scheduled field trips throughout the programming yearBe dismissed unaccompanied by an adult (FIFTH GRADE & OLDER)Be photographed for use in promotional materials and Youth and Family communications

Health Insurance & Emergency Medical Care Authorization

* Medical Insurance Carrier

* Policy / Group Number

* Pediatrician

* Pediatrician's Phone Number

* EMERGENCY MEDICAL CARE AUTHORIZATION: The school shall make every effort to first notify the parents or guardians in the event of a medical emergency. If this is not possible and the staff who are present deem it necessary, I authorize BZBI and Neziner Hebrew School staff to obtain care and treatment for the child, including: permission for BZBI and Neziner Hebrew School staff to perform first aid and/or arrange for emergency response and hospitalization.

EMERGENCY MEDICAL CARE AUTHORIZATION: The school shall make every effort to first notify the parents or guardians in the event of a medical emergency. If this is not possible and the staff who are present deem it necessary, I authorize BZBI and Neziner Hebrew School staff to obtain care and treatment for the child, including: permission for BZBI and Neziner Hebrew School staff to perform first aid and/or arrange for emergency response and hospitalization.

Synagogue Information

* Are you members of Temple Beth Zion-Beth Israel?

Please Select OneYesNo

Are you a member of another synagogue? If so, please identify.

* Will you be registering one or more of your children for Neziner Hebrew School?

Please Select OneYesNo

* By checking this box, you acknowledge that non-member families are required to pay an annual BZBI Maintenance & Security fee of $180, which will be added to the total amount due. If you would like to learn more about our synagogue community and/or discuss synagogue membership, please contact Rabbi Max (education@bzbi.org).

By checking this box, you acknowledge that non-member families are required to pay an annual BZBI Maintenance & Security fee of $180, which will be added to the total amount due. If you would like to learn more about our synagogue community and/or discuss synagogue membership, please contact Rabbi Max (education@bzbi.org).

First Child's Information
Additional children can be registered later in this form

* Child's First Name

* Child's Last Name

* Gender Identity

Date of Birth

Secular School

Grade (2023-2024 school year)

* Is your child new to Youth and Family programs at BZBI?

YesNo

* Does the child have previous experience with Jewish education or peer activities? (please check all that apply)

* What would you like us to know about your child?

REGISTRATION SELECTION

Would you like to register this student for Neziner Hebrew School, which includes: Bonim (pre-K), Gan (K), 1st-7th grade, and Hebrew High (8th-10th grade)?

YesNo

Would you like to register this student for Kadima (5th through 7th Grade youth group)?

YesNo

Kadima Registration

Kadima Youth Group Registration (5th-7th grade) ($72)

Would you like to register this student for USY (8th through 12th Grade youth group)?

Yes (this includes kids who pre-paid via five year commitment already)No

USY Registration

USY 2023-2024 (1 year) Youth Group Registration (8th-12th grade) ($118)USY 2023-2024 for those who prepaid last year (No additional fee)

Teen's Mobile Phone

Teen's Email Address

Would you like to renew your child's registration in a Rosh Hodesh or Shevet group that they participated in last year, or express interest in your child joining a Rosh Hodesh or Shevet group for the first time this year?

YesNo

Rosh Hodesh and Shevet Registration

Eighth Grade Interest in Rosh Hodesh or Shevet (No Fee)Rosh Hodesh - Talia's 9th & 10th Grade Group ($172) - open to new and returning membersRosh Hodesh - Shana's 10th & 11th Grade Group ($172) - registration for returning members onlyRosh Hodesh - Rachel's 11th & 12th Grade Group ($172) - registration for returning members only

Teen's Mobile Phone

Teen's Email Address

CONFIDENTIAL HEALTH INFORMATION

Does your child have any allergies

YesNo

Please list all allergies

Does your child have an epi pen?

YesNo

Do they carry their epi pen with them?

YesNo

Please list any health, learning, or other needs of which we need to need to be aware, including if there is an IEP, 504, or if your child is under regular care of a physical or mental health professional.

ADDITIONAL REGISTRATION

WOULD YOU LIKE TO ADD ANOTHER CHILD?

YesNo

Second Child's Information
Additional children can be registered later in this form

Child's First Name

Child's Last Name

* Gender Identity

Date of Birth

* Secular School

* Grade (2023-2024 school year)

* Is your child new to Youth and Family programs at BZBI?

Please Select OneYesNo

* Does the child have previous experience with Jewish education or peer activities? (please check all that apply)

* What would you like us to know about your child?

REGISTRATION SELECTION

Would you like to register this student for Neziner Hebrew School, which includes: Bonim (pre-K), Gan (K), 1st-7th grade, and Hebrew High (8th-10th grade)?

YesNo

Would you like to register this student for Kadima (5th through 7th Grade youth group)?

YesNo

Kadima Registration

Kadima Youth Group Registration (5th-7th grade) ($72)

Would you like to register this student for USY (8th through 12th Grade youth group)?

Yes (this includes kids who pre-paid via five year commitment already)No

USY Registration

USY 2023-2024 Youth Group Registration (8th-12th grade) ($118)USY 2023-2024 for those who prepaid last year (No additional fee)

Teen's Mobile Phone

Teen's Email Address

YesNo

Rosh Hodesh and Shevet Registration

Teen's Mobile Phone

Teen's Email Address

CONFIDENTIAL HEALTH INFORMATION

Does your child have any allergies

YesNo

Please list all allergies

Does your child have an epi pen?

YesNo

Do they carry their epi pen with them?

YesNo

ADDITIONAL REGISTRATION

WOULD YOU LIKE TO ADD ANOTHER CHILD?

YesNo

Third Child's Information
Additional children can be registered later in this form

* Child's First Name

* Child's Last Name

* Gender Identity

Date of Birth

* Secular School

* Grade (2023-2024 school year)

* Is your child new to Youth and Family programs at BZBI?

YesNo

* Does the child have previous experience with Jewish education or peer activities? (please check all that apply)

* What would you like us to know about your child?

REGISTRATION SELECTION

Would you like to register this student for Neziner Hebrew School, which includes: Bonim (pre-K), Gan (K), 1st-7th grade, and Hebrew High (8th-10th grade)?

YesNo

Would you like to register this student for Kadima (5th through 7th Grade youth group)?

YesNo

Kadima Registration

Kadima Youth Group Registration (5th-7th grade) ($72)

Would you like to register this student for USY (8th through 12th Grade youth group)?

Yes (this includes kids who pre-paid via five year commitment already)No

USY Registration

USY 2023-2024 (1 year) Youth Group Registration (8th-12th grade) ($118)USY 2023-2024 for those who prepaid last year (No additional fee)

Mobile Phone for Teen Being Registered

Email Address for Teen Being Registered

YesNo

Rosh Hodesh and Shevet Registration

Mobile Phone for Teen Being Registered

Email Address for Teen Being Registered

CONFIDENTIAL HEALTH INFORMATION

Does your child have any allergies

YesNo

Please list all allergies

Does your child have an epi pen?

YesNo

Do they carry their epi pen with them?

YesNo

ADDITIONAL REGISTRATION

WOULD YOU LIKE TO ADD ANOTHER CHILD?

YesNo

Fourth Child's Information

Child's First Name

Child's Last Name

Gender Identity

Date of Birth

Secular School

Grade (2023-2024 school year)

Is your child new to Youth and Family programs at BZBI?

YesNo

* Does the child have previous experience with Jewish education or peer activities? (please check all that apply)

* What would you like us to know about your child?

REGISTRATION SELECTION

Would you like to register this student for Neziner Hebrew School, which includes: Bonim (pre-K), Gan (K), 1st-7th grade, and Hebrew High (8th-10th grade)?

YesNo

Would you like to register this student for Kadima (5th through 7th Grade youth group)?

YesNo

Kadima Registration

Kadima Youth Group Registration (5th-7th grade) ($72)

Would you like to register this student for USY (8th through 12th Grade youth group)?

Yes (this includes kids who pre-paid via five year commitment already)No

USY Registration

USY 2023-24 (1 year) Youth Group Registration (8th-12th grade) ($118)USY 2023-2024 for those who prepaid last year (No additional fee)

Mobile Phone for Teen Being Registered

Email Address for Teen Being Registered

YesNo

Rosh Hodesh and Shevet Registration

Mobile Phone for Teen Being Registered

Email Address for Teen Being Registered

CONFIDENTIAL HEALTH INFORMATION

Does your child have any allergies

YesNo

Please list all allergies

Does your child have an epi pen?

YesNo

Do they carry their epi pen with them?

YesNo

ADDITIONAL REGISTRATION

WOULD YOU LIKE TO ADD ANOTHER CHILD?

YesNo

To register additional children, please complete a second form.

EMERGENCY CONTACTS & ADDITIONAL AUTHORIZED ADULTS

* Emergency Contact 1 (also authorized to pick up children from Youth and Family activities)

* Relationship

* Home Phone

* Mobile Phone

Add a second emergency contact?

YesNo

* Emergency Contact 2 (also authorized to pick up children from Youth and Family activities)

* Relationship

* Home Phone

* Mobile Phone

PAYMENT

- There are three payment options:
If you are logged into your ShulCloud account you can:

(1) Pay by credit card online (there is a 3.5% credit card fee)
(2) Pay by e-check online (there is a 1.5% fee to pay by e-check)
(3) "Bill to my Account." If you select this option the synagogue will generate an
invoice and add it to your account. Please note: (1) Selecting this option
constitutes an agreement to pay the invoiced amount by or before Tuesday,
August 15, 2023. (2) This option is only available to synagogue members.

- Tuition Refunds: We hire staff, purchase supplies, and make other important
decisions based on our enrollment numbers. For that reason, if a family chooses to
unenroll a student...

*Before June 15, 2023: we will refund 70% of tuition and fees
*Before July 15, 2023: we will refund 50% of tuition and fees
*Before August 15, 2023: we will refund 25% of tuition and fees

*On or after August 15, 2023: no refunds will be issued

- Hebrew School Tuition for a Child Only Attending Once/Week

*If NOT also enrolled in another Jewish Education program, tuition is prorated by 33% (There is
NO proration for Bonim or Gan as these programs only meet once a week by design).

*If the child attends Hebrew School once a week AND is also enrolled in another Jewish
Education program of similar or greater intensity as Neziner Hebrew School, tuition is
prorated by 50%.

*If your child is in 1st - 7th grade and will only attend Hebrew School once per week, contact the Director (education@bzbi.org) for an alternate version of this form. If you have more than one child in 1st - 7th grade enrolling in Hebrew School, and one will attend twice a week but the other will only attend once a week, you will need to complete two forms (this form and the alternate form).

Parent-Teacher Association Contribution

Support the PTA ($36)The Youth & Family Parent Teacher Association (PTA) is a dedicated group of parents whose activities enhance the life of our program throughout the year. The PTA raises money for special projects, organizes an array of holiday and community events for students and families, and gives holiday and end-of-year gifts to our devoted teaching staff. Your contribution is extremely important to achieve the PTA programming and fundraising goals.

As you may know, tuition for Neziner Hebrew School and other Youth and Family programs only covers about 65% of our programs' total budget. If possible, please consider making a tax-deductible contribution to help cover the remaining 35% of our programming costs:

Additional Contribution

* I confirm that all the information provided in this form is true, and I understand that by signing it I acknowledge and agree to all the above statements.

I confirm that all the information provided in this form is true, and I understand that by signing it I acknowledge and agree to all the above statements.

* Please type your name here to indicate agreement

Total Due

If you have any questions about the registration form, you can refer to the FAQs or contact the Director of Youth & Family Education.

Tue, May 7 2024 29 Nisan 5784