BZBI Youth & Family Education 5781-5782 (2021-2022) Registration

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A Message from Rabbi Max

A Message from Rabbi Max

I, together with the Youth and Family Education Committee and Teen Programs Coordinator Rachel Beck, am thrilled that your child(ren) will be part of our Youth and Family Education community at BZBI! Youth and Family Education includes our Neziner Hebrew School, youth groups for children from fifth grade through high school, and other special programs for children and families of all ages to learn, build community, and celebrate together. You can use this form to register your child(ren) for Hebrew School and/or our youth groups.

The past year has been difficult for many of our families. We have all faced major disruptions to our and our children’s lives, and pray that next year will open up new opportunities to be together and return to a routine that is closer to “normal.” As we look forward to the future with optimism, I am excited to announce that we plan to return to in-person Hebrew School, and Youth and Family programming, for the 2021-2022 school year! The Youth and Family Committee, the synagogue’s Back to Shul Taskforce, Rachel Beck, and I are working to ensure that we will return to in-person programming safely.

While we fully anticipate returning to a full in-person program, please note that some of the specific details presented below may shift as various synagogue committees continue to work toward finalizing safety measures and synagogue policies. With regard to Hebrew School, what this means is that while there may be slight changes to the timing of classes, we do not anticipate major changes (i.e. the days when classes will take place, or dramatic changes in the times when class will meet). Please also note that, as always, our programming calendar is subject to change as events and programs are added and edited throughout the year. Please always consult the most up-to-date Youth and Family calendar, which you can find on the Youth and Family page of the BZBI website.

Finally, I want to express once again how excited I am to be able to learn and play in-person in the fall! This has been a challenging year, and I am so looking forward to reconnecting with our students, teachers, and families. If you have any questions, please feel free to reach out to me (education@bzbi.org), and I can’t wait to see you at BZBI soon!

L’Shalom,
Rabbi Max

This form can be used to register all your children for all BZBI Youth & Family activities, including Hebrew School, USY, and Kadima. It takes approximately 15 minutes to complete. If you log into ShulCloud first, information already in the system will pre-populate the form. Please leave enough time to complete the entire form, as information cannot be saved. Questions? Call the Temple Office at 215-735-5148.

Neziner Hebrew School Schedule

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.

Hebrew Name (if applicable)

Occupation

* Street Address (Line 1)

Street Address, Line 2

* City

* State

* ZIP Code

* Email Address

* Mobile Phone

* Home Phone

Work Phone

Please Check the Statements that Apply

I would like to get involved as a class Parent Ambassador or am interested in volunteeringI would like to opt out of text notificationsI give my permission to share contact information in class and school directories

Do you want to add a second parent / guardian?

NoYes

* First Name

* Last Name

Hebrew Name (if applicable)

Occupation

* Street Address (Line 1)

Street Address, Line 2

* City

* State

* ZIP Code

* Email Address

* Mobile Phone

Home Phone

Work Phone

Please Check the Statements that Apply

Do you want to add a third parent / guardian?

NoYes

First Name

Last Name

Hebrew Name (if applicable)

Occupation

Street Address (Line 1)

Street Address, Line 2

City

State

ZIP Code

Email Address

Mobile Phone

Home Phone

Work Phone

Please Check the Statements that Apply

Do you want to add a fourth parent / guardian?

NoYes

First Name

Last Name

Hebrew Name (if applicable)

Occupation

Street Address (Line 1)

Street Address, Line 2

City

State

ZIP Code

Email Address

Mobile Phone

Home Phone

Work Phone

Please Check the Statements that Apply

To add additional parents/guardians, please call the Youth & Family office.

Health Insurance Information

* Medical Insurance Carrier

* Policy / Group Number

* Pediatrician

* Pediatrician's Phone Number

Synagogue Information

Are you members of Temple Beth Zion-Beth Israel?

NoYes

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

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

NoYes

Please explain

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

* Child's First Name

* Child's Last Name

* Child's Hebrew Name

If you would like help in choosing a Hebrew name
for your child, please reach out to us.

Nickname

* Gender Identity

Date of Birth

Secular School

Grade in Secular School (2021-2022)

Grade in Neziner Hebrew School (2021-2022)

* Is your child new to the Neziner Hebrew School?

NoYes

REGISTRATION SELECTION

Would you like to register this student for Neziner Hebrew School (pre-K through Hebrew High)?

NoYes

Hebrew School Registration

Bonim (pre-K): Saturday, 10:00 AM - 12:30 PM ($360)Gan (Kindergarten): Saturday, 10:00 AM - 12:30 PM ($980)1st-3rd Grade: Monday, 4:00 - 6:00 PM & Saturday, 10:00 AM - 12:30 PM; Enrichment on Wednesday, 4:00 -6:00 PM ($1,480)4th-7th Grade: Wednesday, 4:00 - 6:00 PM & Saturday, 10:00 AM - 12:30 PM; Enrichment on Monday, 4:00 - 6:00 PM ($1,480)7th grade pizza dinner with Hebrew High: Wednesday, 6:00 - 6:30 PM ($100)8th Grade Hebrew High (includes dinner): 6:00 - 8:00 PM ($1,120)9th Grade Hebrew High (includes dinner): 6:00 - 8:00 PM ($1,120)

I am deciding to opt my child out of the Adasha enrichment class (1st - 3rd Grade: Wednesdays from 4:00 - 6:00; 4th - 7th Grade: Mondays from 4:00 - 6:00). They will not be participating in this enrichment class, which is included with tuition and is part of our program.

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

NoYes

Kadima Registration

Kadima 2021 Youth Group Registration (5th-7th grade) ($54)

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

NoYes

USY Registration

USY 2021 (1 year) Youth Group Registration (8th-12th grade) ($100)USY- 2021-2026 (5 years) for rising 8th graders ONLY ($450)

Mobile Phone for Teen Being Registered

Email Address for Teen Being Registered

Would you like to renew your child's registration in a Rosh Hodesh or Shevet group that they participated in last year (rising 8th grade families will have an opportunity to sign up for new Rosh Hodesh and Shevet groups at a later date on a separate form)?

NoYes

Rosh Hodesh and Shevet Registration

Rosh Hodesh Registration ($150)Shevet Registration ($150)

Mobile Phone for Teen Being Registered

Email Address for Teen Being Registered

Please share what you hope your teen/pre-teen will get out of this experience (for example: greater self-esteem, more positive peer-to-peer relationships, increased Jewish identity, increased feeling of empowerment to discuss and advocate for things they care about)

I give my permission to have my child's (registered above) photograph/video image and name used in the charitable and educational programs of Moving Traditions, its sponsors, and funders, and in any print or electronic media, including brochures, advertisements, annual reports, Web sites, and other materials, that are used to promote Moving Traditions, its sponsors, and funders.

ADDITIONAL INFORMATION

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

* Please share some of your child's strengths:

* Please share some examples of what your child finds challenging:

CONFIDENTIAL HEALTH INFORMATION

* Does your child take any medications that we need to be aware of, or that you would like to make us aware of?

NoYes

Please list all medications

Does your child have any allergies

NoYes

Please list all allergies

* Does your child have an epi pen?

Please Select OneNoYes

Do they carry their epi pen with them?

NoYes

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.

Would you like to provide us with additional information in person?

NoYesIf yes, we will contact you.

ADDITIONAL REGISTRATION

WOULD YOU LIKE TO ADD ANOTHER CHILD?

NoYes

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

* Child's First Name

* Child's Last Name

* Child's Hebrew Name

If you would like help in choosing a Hebrew name
for your child, please reach out to us.

Nickname

* Gender Identity

Date of Birth

* Secular School

* Grade in Secular School (2021-2022)

Grade in Neziner Hebrew School (2021-2022)

* Is your child new to the Neziner Hebrew School?

Please Select OneNoYes

REGISTRATION SELECTION

Would you like to register this student for Neziner Hebrew School (pre-K through Hebrew High)?

NoYes

Hebrew School Registration

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

NoYes

Kadima Registration

Kadima 2021 Youth Group Registration (5th-7th grade) ($54)

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

NoYes

USY Registration

USY 2021 (1 year) Youth Group Registration (8th-12th grade) ($100)USY- 2021-2026 (5 years) for rising 8th graders ONLY ($450)

Mobile Phone for Teen Being Registered

Email Address for Teen Being Registered

NoYes

Rosh Hodesh and Shevet Registration

Rosh Hodesh Registration ($150)Shevet Registration ($150)

Mobile Phone for Teen Being Registered

Email Address for Teen Being Registered

ADDITIONAL INFORMATION

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

* Please share some of your child's strengths:

* Please share some examples of what your child finds challenging:

CONFIDENTIAL HEALTH INFORMATION

* Does your child take any medications that we need to be aware of, or that you would like to make us aware of?

NoYes

Please list all medications

* Does your child have any allergies

Please Select OneNoYes

Please list all allergies

* Does your child have an epi pen?

Please Select OneNoYes

Do they carry their epi pen with them?

NoYes

Would you like to provide us with additional information in person?

NoYes

ADDITIONAL REGISTRATION

WOULD YOU LIKE TO ADD ANOTHER CHILD?

NoYes

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

* Child's First Name

* Child's Last Name

* Child's Hebrew Name

If you would like help in choosing a Hebrew name
for your child, please reach out to us.

Nickname

* Gender Identity

Date of Birth

* Secular School

* Grade in Secular School (2021-2022)

Grade in Neziner Hebrew School (2021-2022)

* Is your child new to the Neziner Hebrew School?

NoYes

REGISTRATION SELECTION

Would you like to register this student for Neziner Hebrew School (pre-K through Hebrew High)?

NoYes

Hebrew School Registration

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

NoYes

Kadima Registration

Kadima 2021 Youth Group Registration (5th-7th grade) ($54)

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

NoYes

USY Registration

USY 2021 (1 year) Youth Group Registration (8th-12th grade) ($100)USY- 2021-2026 (5 years) for rising 8th graders ONLY ($450)

Mobile Phone for Teen Being Registered

Email Address for Teen Being Registered

NoYes

Rosh Hodesh and Shevet Registration

Rosh Hodesh Registration ($150)Shevet Registration ($150)

Mobile Phone for Teen Being Registered

Email Address for Teen Being Registered

ADDITIONAL INFORMATION

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

* Please share some of your child's strengths:

* Please share some examples of what your child finds challenging:

CONFIDENTIAL HEALTH INFORMATION

* Does your child take any medications that we need to be aware of, or that you would like to make us aware of?

Please Select OneNoYes

Please list all medications

* Does your child have any allergies

Please Select OneNoYes

Please list all allergies

* Does your child have an epi pen?

Please Select OneNoYes

Do they carry their epi pen with them?

NoYes

Would you like to provide us with additional information in person?

NoYes

ADDITIONAL REGISTRATION

WOULD YOU LIKE TO ADD ANOTHER CHILD?

NoYes

Fourth Child's Information
To register additional children, please complete a second form

Child's First Name

Child's Last Name

Child's Hebrew Name

If you would like help in choosing a Hebrew name
for your child, please reach out to us.

Nickname

Gender Identity

Date of Birth

Secular School

Grade in Secular School (2021-2022)

Grade in Neziner Hebrew School (2021-2022)

Is your child new to the Neziner Hebrew School?

NoYes

REGISTRATION SELECTION

Would you like to register this student for Neziner Hebrew School (pre-K through Hebrew High)?

NoYes

Hebrew School Registration

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

NoYes

Kadima Registration

Kadima 2021 Youth Group Registration (5th-7th grade) ($54)

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

NoYes

USY Registration

USY 2021 (1 year) Youth Group Registration (8th-12th grade) ($100)USY- 2021-2026 (5 years) for rising 8th graders ONLY ($450)

Mobile Phone for Teen Being Registered

Email Address for Teen Being Registered

NoYes

Rosh Hodesh and Shevet Registration

Rosh Hodesh Registration ($150)Shevet Registration ($150)

Mobile Phone for Teen Being Registered

Email Address for Teen Being Registered

ADDITIONAL INFORMATION

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

* Please share some of your child's strengths:

* Please share some examples of what your child finds challenging:

CONFIDENTIAL HEALTH INFORMATION

* Does your child take any medications that we need to be aware of, or that you would like to make us aware of?

Please Select OneNoYes

Please list all medications

* Does your child have any allergies

Please Select OneNoYes

Please list all allergies

* Does your child have an epi pen?

Please Select OneNoYes

Do they carry their epi pen with them?

NoYes

Would you like to provide us with additional information in person?

NoYes

ADDITIONAL REGISTRATION

WOULD YOU LIKE TO ADD ANOTHER CHILD?

NoYes

To register additional children, please complete a second form.

EMERGENCY INFORMATION AND AUTHORIZATION

* I understand that 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 situation necessitates immediate action, I authorize the administrator and staff of the Neziner Hebrew School to obtain care and treatment for the child, including first aid and/or hospitalization.

I understand that 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 situation necessitates immediate action, I authorize the administrator and staff of the Neziner Hebrew School to obtain care and treatment for the child, including first aid and/or hospitalization.

* Emergency Contact 1

* Relationship

* Home Phone

* Mobile Phone

This person is also authorized to pick up my child(ren).

Add a second emergency contact?

NoYes

* Emergency Contact 2

* Relationship

* Home Phone

* Mobile Phone

This person is also authorized to pick up my child(ren).

To add additional emergency contacts, contact the Youth & Family office.

PICKUP INFORMATION

Other than the parent(s), guardian(s) and/or adults listed above, is anyone else authorized to pick up your child(ren)?

NoYes

Name of Person

Relationship

Home Phone

Mobile Phone

Add another authorized person?

NoYes

Name of Person

Relationship

Home Phone

Mobile Phone

Add another authorized person?

NoYes

Name of Person

Relationship

Home Phone

Mobile Phone

To add additional authorized people, please contact Youth & Family education.

PERMISSIONS

Check the permissions that you authorize

I give permission for my child(ren) to participate in supervised walks around the synagogue and scheduled field trips throughout the school year.My child has permission to be dismissed unaccompanied by an adult (5th grade and older)I give permission for my child(ren) to be photographed for in-school use or for use in promotional materials for the school or synagogue.

PAYMENT

Your tuition payment helps offset the cost of running our education program. It covers registration, books, snacks, supplies, and other related expenses.

A minimum deposit of $100 is due upon submitting this form. You can pay the deposit or full tuition via credit card on this form. Alternatively, you may skip the credit card payment option and instead elect to mail a deposit or tuition check to the synagogue within a week of submitting this form.

Submitting this form without completing credit card information indicates your intent to mail in a paper check. Please include "NHS Deposit/Tuition" and the name of the child(ren) payment is for on the memo line, and make checks out to "Temple Beth Zion-Beth Israel." You can mail paper checks to:

Temple Beth Zion-Beth Israel

300 South 18th Street

Philadelphia, PA 19103

Tuition should be paid in full by the first day of school.

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.

Additional Neziner Contribution (Tax-Deductable)

As you may know, tuition for Neziner Hebrew school only covers about 65% of the program’s total budget. If you would like and are able to help cover part of the remaining 35% of Neziner's costs, please consider making an 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

Payment online, or any credit card payment in person, incurs a 2.5% transaction fee.

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

Wed, December 1 2021 27 Kislev 5782