Bet Limmud Registration Form 2024-25

Parent 1 First Name

Parent 1 Last Name

* Preferred Phone Parent 1

Email Parent 1

First Name Parent 2

Last Name Parent 2

Preferred Phone Parent 2

Email Parent 2

Emergency Contact #1 (Name, Relation and Phone Number)

Emergency Contact #2 (Name, Relation and Phone Number)

* First Name Student 1

* Last Name Student 1

Birthdate Student 1

* Current Grade Student 1

Pronouns Student 1

Preferred Name or Nickname Student 1 (If different)

Hebrew Name Student 1 (English Alphabet) and include parents' Hebrew names if known

Hebrew Name Student 1 (Hebrew Letters if known)

Name of School-Student 1

* Student 2 First Name

Last Name Student 2

Birthdate Student 2

* Current Grade Student 2

Pronouns Student 2

Preferred Name or Nickname Student 2 (If different)

Hebrew Name Student 2 (English Alphabet) (please include any parents' Hebrew names if known)

Hebrew Name Student 2 (Hebrew Letters if known)

Name of School-Student 2

* Student 1: Please share a little about your child's general temperament and learning style for the sake of trying to create a positive learning environment for them.

* Student 1: Tell us some of your child's likes and dislikes, hobbies, interests and/or extra-curricular activities.

Student 2: Please share a little about your child's general temperament and learning style for the sake of trying to create a positive learning environment for them.

* Student 2: Tell us some of your child's likes and dislikes, hobbies, interests and/or extra-curricular activities.

Who does/do student(s) live with?

* Medical Authorization

By signing my name above, my child(ren) have permission to participate in the Bet Limmud School at Congregation Bet Shalom. I hereby authorize the school coordinator to obtain emergency medical care for my child(ren) in the event such care is indicated. I give my permission for my child(ren) to receive emergency medical care by any nurse, doctor, paramedic or member of a medical staff of a hospital licensed by the State of Arizona. I understand that every effort will be made to notify a parent/guardian prior to treatment.

I certify that my child(ren) is(are) in good physical health. They have my permission to participate in all activities that are part of the regular Bet Limmud program.

* Medical Release: Enter your name above.

Attendance Agreement

I understand that Bet Limmud sessions will take place on Sundays at 10am-noon during most weeks of the school year. I intend for my child to attend as many of these sessions as possible when not ill or out of town- understanding that learning time is limited and we want to make the most of it.

For students in 3-5th grade, weekly 30-minute virtual Hebrew language learning sessions will be scheduled at a time convenient to the family.

In additon, we will make every effort to attend the four seasonal Friday night dinners and services on
September 13
December 6
February 7
May 2

* Attendence Agreement- Enter your name above.

Number of Children for Registration

* Tuition

Our tuition is based on a sliding scale annual fee of $360-900 per student. Please choose an amount that works for your family. No one will be turned away for lack of funds. For need-based scholarship information, please contact Lisa (lisa@cbsaz.org or 520.233.7813.)

On the next screen you will be able to set up monthly payments. Simply click on the dropdown next to "Pay this Amount" and change it from "Once Now" to however many payments you'd like to set up. It is recommended to pay it in 12 payments or less.

Sun, September 15 2024
12 Elul 5784

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Sun, September 15 2024 12 Elul 5784

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