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2023-2024 Be Wise Registration
Please verify reCaptcha before submitting the form.
STUDENT INFORMATION
*
How many students are being registered?
Please Select One
One Student
Two Students
Three Students
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
Please Select One
Female
Male
Non-Binary
*
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?
Please Select One
Yes
No
Student 1 - Please upload a copy of the IEP here
if applicable
Student 1 - Does this student have any allergies or medical conditions?
Please Select One
Yes
No
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-12:20pm
Wednesdays 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 - 12:20pm
Wednesdays 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-12:20pm
Wednesdays 4:30pm-6:00pm
STUDENT 2 INFORMATION
*
Student 2 - First Name
*
Student 2 - Last Name
*
Student 2 - Gender
Please Select One
Female
Male
Non-Binary
*
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?
Please Select One
Yes
No
Student 2 - Please upload a copy of the IEP here
if applicable
Student 2 - Does this student have any allergies or medical conditions?
Please Select One
Yes
No
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-12:20pm
Wednesdays 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-12:20pm
Wednesdays 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-12:20pm
Wednesdays 4:30pm-6:00pm
STUDENT 3 INFORMATION
*
Student 3 - First Name
*
Student 3 - Last Name
*
Student 3 - Gender
Please Select One
Female
Male
Non-Binary
*
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?
Please Select One
Yes
No
Student 3 - Please upload a copy of the IEP here
if applicable
Student 3 - Does this student have any allergies or medical conditions?
Please Select One
Yes
No
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-12:20pm
Wednesdays 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-12:20pm
Wednesdays 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-12:20pm
Wednesdays 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
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code
*
Is there a second Parent?
Please Select One
Yes
No
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?
Please Select One
Yes
No
PARENT 2 ADDRESS
*
Address
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code
Total Deposit
Fri, January 17 2025 17 Tevet 5785
