2023-2024 Be Wise Registration

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STUDENT INFORMATION

* How many students are being registered?

There is a $180 deposit per student registered that will be put towards the first minimester your student attends.

STUDENT 1 INFORMATION

* Student 1 - First Name

* Student 1 - Last Name

* Student 1 - Gender

* Student 1 - Date of Birth

* Student 1 - Hebrew Name

* Student 1 - Grade as of Sept. 2023

* Student 1 - Public/Day School

* Student 1 - Specific Interests

* Student 1 - Does this student have an IEP?

Student 1 - Please upload a copy of the IEP here

if applicable

Student 1 - Does this student have any allergies or medical conditions?

Student 1 - Please provide any allergy or medical information here:

if applicable

* Student 1 - Name 3 potential tutoring days and times (Grades 3-7 only)

Please note you may not get your first three choices.

Student 1-Please check the box below if your child will be attending the Fall session

Fall - September 10 - December 3

Student 1- If student is to attend Fall minimester please indicate the time(s) you would like them to attend class

Sundays 9:30am-12:20pmWednesdays 4:30pm-6:00pm

Student 1-Please check the box below if your child will be attending the Winter session

Winter - December 3 - February 11

* Student 1 - If student is to attend Winter minimester please indicate the time(s) you would like them to attend class

Sundays 9:30am - 12:20pmWednesdays 4:30pm - 6:00pm

* Student 1 - Please check the box below if your child will be attending the Spring session

Spring - March 3 - May 6

Student 2- If student is to attend Spring minimester please indicate the time(s) you would like them to attend class

Sundays 9:30am-12:20pmWednesdays 4:30pm-6:00pm

STUDENT 2 INFORMATION

* Student 2 - First Name

* Student 2 - Last Name

* Student 2 - Gender

* Student 2 - Date of Birth

* Student 2 - Hebrew Name

* Student 2 - Grade as of Sept. 2023

* Student 2 - Public/Day School

* Student 2 - Specific Interests

* Student 2 - Does this student have an IEP?

Student 2 - Please upload a copy of the IEP here

if applicable

Student 2 - Does this student have any allergies or medical conditions?

Student 2 - Please provide any allergy or medical information here:

if applicable

* Student 2 - Name 3 potential tutoring days and times (Grades 3-7 only)

Please note you may not get your first three choices.

* Student 2 - Please check the box below if your child will be attending the Fall minimester

Fall - September 10 - December 3

Student 2 - If student is to attend Fall minimester please indicate the time you would like them to attend class

Sundays 9:30am-12:20pmWednesdays 4:30pm-6:00pm

Student 2- Please check the box below if your child will be attending the Winter minimester

Winter - December 3 - February 11

Student 2 - If student is to attend Winter minimester please indicate the time(s) you would like them to attend class

Sundays 9:30am-12:20pmWednesdays 4:30pm-6:00pm

Student 2 - Please check the box below if you child will be attending the Spring minimester

Spring - March 3 - May 6

Student 2 - If student is to attend Spring minimester please indicate the time(s) you would like them to attend class

Sundays 9:30am-12:20pmWednesdays 4:30pm-6:00pm

STUDENT 3 INFORMATION

* Student 3 - First Name

* Student 3 - Last Name

* Student 3 - Gender

* Student 3 - Date of Birth

* Student 3 - Hebrew Name

* Student 3 - Grade as of Sept. 2023

* Student 3 - Public/Day School

* Student 3 - Specific Interests

* Student 3 - Does this student have an IEP?

Student 3 - Please upload a copy of the IEP here

if applicable

Student 3 - Does this student have any allergies or medical conditions?

Student 3 - Please provide any allergy or medical information here:

if applicable

* Student 3 - Name 3 potential tutoring days and times (Grades 3-7 only)

Please note you may not get your first three choices.

* Student 3 - Please check the box below if your child will be attending the Fall session

Fall - September 10 - December 3

* Student 3 - If student is to attend Fall minimester please indicate the time(s) you would like them to attend class

Sundays 9:30am-12:20pmWednesdays 4:30pm-6pm

Student 3 - Please check the box below if your child will be attending the Winter session

Winter - December 3 - February 11

Student 3 - If student is to attend Winter minimester please indicate the time(s) you would like them to attend class

Sundays 9:30am-12:20pmWednesdays 4:30-6:00pm

Student 3 - Please check the box below if your child will be attending the Spring session

Spring - March 3 - May 6

Student 3 - If student is to attend Spring minimester please indicate the time(s) you would like them to attend class

Sundays 9:30am-12:20pmWednesdays 4:30-6:00pm

PARENT 1 INFORMATION

* Parent 1 - First Name

* Parent 1 - Last Name

* Parent 1 - Email Address

* Parent 1 - Mobile Phone

* Address

* City

* State

* Zip Code

* Is there a second Parent?

PARENT 2 INFORMATION

* Parent 2 - First Name

* Parent 2 - Last Name

* Parent 2 -Email Address

* Parent 2 - Mobile Phone

* Does Parent 2 live at the same address?

PARENT 2 ADDRESS

* Address

* City

* State

* Zip Code

Total Deposit

Fri, July 26 2024 20 Tammuz 5784