BE.WISE 2024-2025 Registration

Home
Donate

Home
Donate

Parent Information

* Parent #1 First Name

* Parent #1 Last Name

* Parent #1 Email

Parent #1 Cell Phone

* Parent #1 Full Address

Emergency Contact #1 Phone Number

Parent #2 First Name

Parent #2 Last Name

Parent #2 Email

Parent # 2 Cell Phone

Parent #2 Full Address (if different)

Parent #2 Work Phone Number

Emergency Contact Information

Note: Emergency contacts should be someone other than a parent

* Emergency Contact #1 Name

Emergency Contact #1 Phone Number

Emergency Contact #1 Relationship to Student

* Emergency Contact #2 Name

Emergency Contact #2 Phone Number

* Emergency Contact #2 Relationship to Student

Any adults other than a parent/guardian that are authorized for pick up:

Name(s) and relationship to student

Student Information

* How many students are you registering?

Please note that this registration is for the entire BE.WISE year, priced at $540 per child. Please contact Stephen Papkin if there are questions.

Student 1

* Student First Name

* Student Last Name

Hebrew name (if applicable)

* Student Date of Birth

Hebrew birthday (If applicable)

* Current grade (2024/2025 academic year)

* Are they new to BE.WISE?

YesNo

Allergies (if applicable)

Dietary restrictions (if applicable)

Note: The BE.WISE program embraces the uniqueness of each student. Detailed answers will help us ensure the safest and most successful school year possible. Any additional information that you share will be confidential:

Does this student have special medical considerations? (medications, limitations on physical activity, etc.)

Any information about the student's home or school life that you feel would be useful to share:

Any information about your child's relationship to Judaism that you would like to share:

Does your child have an Individualized Education Plan or Section 504 Plan that would help them to reach their maximum potential?

Student 2

Student First Name

Student Last Name

Hebrew name (if applicable)

Student Date of Birth

Hebrew birthday (If applicable)

Current grade (2024/2025 academic year)

Are they new to BE.WISE?

YesNo

Allergies (if applicable)

Dietary restrictions (if applicable)

Does this student have special medical considerations? (medications, limitations on physical activity, etc.)

Any information about the student's home or school life that you feel would be useful to share:

Any information about your child's relationship to Judaism that you would like to share:

Does your child have an Individualized Education Plan or Section 504 Plan that would help them to reach their maximum potential?

Student 3

Student First Name

Student Last Name

Hebrew name (if applicable)

Student Date of Birth

Hebrew birthday (If applicable)

Current grade (2024/2025 academic year)

Are they new to BE.WISE?

YesNo

Allergies (if applicable)

Dietary restrictions (if applicable)

Does this student have special medical considerations? (medications, limitations on physical activity, etc.)

Any information about the student's home or school life that you feel would be useful to share:

Any information about your child's relationship to Judaism that you would like to share:

Does your child have an Individualized Education Plan or Section 504 Plan that would help them to reach their maximum potential?

Student 4

Student First Name

Student Last Name

Hebrew name (if applicable)

Student Date of Birth

Hebrew birthday (If applicable)

Current grade (2024/2025 academic year)

Are they new to BE.WISE?

YesNo

Allergies (if applicable)

Dietary restrictions (if applicable)

Does this student have special medical considerations? (medications, limitations on physical activity, etc.)

Any information about the student's home or school life that you feel would be useful to share:

Any information about your child's relationship to Judaism that you would like to share:

Does your child have an Individualized Education Plan or Section 504 Plan that would help them to reach their maximum potential?

I authorize the use of photographs of my child for Temple Beth El and BE.WISE advertising. No names will ever be used without additional parent permission.

* Signature of Parent or Guardian

* We have read and understand this enrollment contract and agree that by signing below it we accept responsibility for all financial obligations contained herein.

Financial Agreement

* Persons(s) below are responsible for payments to Temple Beth El (please type names below, this will act as a legal signature).

Payer Agreement

* I understand that, if paying by charge card, there will be a 3% surcharge applied to offset necessary system fees. If you would like to pay by paper check, please call the office at (585)473-1770 to discuss options.

Credit Card Agreement

Financial aid is available. Please apply through this form.

A payment plan must be set up upon confirmation with full payment due by March 31, 2025. If you do not set up a plan, one will be set up for you, recurring on the 1st of every month starting September 1, 2024.

Thu, August 22 2024 18 Av 5784