2024-2025 Religious School Registration - Form - Beth El Congregation of the South Hills

Spiegel School Registration 2024-2025

Welcome to the Spiegel Religious School of Beth El Congregation. Please complete the form below to register your child(ren) for the upcoming school year. If you have any questions, please contact Rabbi Amy Greenbaum

Section A: Family Contact Information

* First Name (Parent #1)

* Last Name (Parent #1)

* Email (Parent #1)

* Cell Phone (Parent #1)

* Relationship to Student(s) (Parent #1)

* Street Address (Parent #1)

Street Address Line 2 (Parent #1)

* City (Parent #1)

* State (Parent #1)

* ZIP (Parent #1)

* Is there a Parent #2 contact?

Please Select OneNoYes, at the same address as Parent #1Yes, but at a different address than Parent #1If there is a Parent #2 contact, all emails and mailings will go to both contacts. In case of urgent need, Parent #1 will be notified first

* First Name (Parent #2)

* Last Name (Parent #2)

* Email (Parent #2)

* Phone (Parent #2)

* Relationship to Student(s) (Parent #2)

* Street Address (Parent #2)

Street Address Line 2 (Parent #2)

* City (Parent #2)

* State (Parent #2)

* ZIP (Parent #2)

Emergency Contacts

* Emergency Contact Name (Primary)

* Emergency Contact Phone (Primary)

* Emergency Contact Relationship (Primary)

* Emergency Contact Name (Secondary)

* Emergency Contact Phone (Secondary)

* Emergency Contact Relationship (Secondary)

Section B: Student Enrollment Information

Student 1 Information

* Student 1 First Name

* Student 1 Last Name

* Student 1 Birthdate

* Student 1 Grade in Religious School

* Student 1 School District

* Student 1 Special Learning Needs

Please Select OneNoYesIf yes, Rabbi Amy Greenbaum would love to sit down with you and your child’s teacher before the school year begins so that we are able to discuss the best ways to support your child from the outset. If you are comfortable we invite you to send any documentation (e.g. an IEP or 504) ahead of time to rabbiamy@bethelcong.org.

* Student 1 Special Learning Needs

Please briefly describe your child's special learning needs

* Student 1 Allergies or Medical Issues

Please Select OneNoYesDoes your child have allergies or medical issues we need to know about?

Student 1 Allergy/Medical Issues

Please describe allergies and medical issues.

Student 2 Information

* Student 2 First Name

* Student 2 Last Name

* Student 2 Birthdate

* Student 2 Grade in Religious School

* Student 2 School District

* Student 2 Special Learning Needs

Please briefly describe your child's special learning needs

* Student 2 Allergies or Medical Issues

Please Select OneNoYesDoes your child have allergies or medical issues we need to know about?

Student 2 Allergy/Medical Issues

Please describe allergies and medical issues.

Student 3 Information

* Student 3 First Name

* Student 3 Last Name

* Student 3 Birthdate

* Student 3 Grade in Religious School

* Student 3 School District

* Student 3 Special Learning Needs

Please briefly describe your child's special learning needs

* Student 3 Allergies or Medical Issues

Please Select OneNoYesDoes your child have allergies or medical issues we need to know about?

Student 3 Allergy/Medical Issues

Please describe allergies and medical issues.

Student 4 Information

* Student 4 First Name

* Student 4 Last Name

* Student 4 Birthdate

* Student 4 Grade in Religious School

* Student 4 School District

* Student 4 Special Learning Needs

Please briefly describe your child's special learning needs

* Student 4 Allergies or Medical Issues

Please Select OneNoYesDoes your child have allergies or medical issues we need to know about?

Student 4 Allergy/Medical Issues

Please describe allergies and medical issues.

Section C: Release Forms

Physical Activity Consent

Parental Consent for Child/Children to Participate in Physical Activities

I, as a parent or legal guardian, give my permission for my child/children listed in this registration form to participate in any activities both on and off the grounds of Beth El Congregation for class and/or activities as part of the Spiegel Religious School. Activities may include, but are not limited to: Gaga, Relay Races, Cooking and field trips. I do not/will not hold Beth El Congregation, its faculty, administrative personnel, employees, or other personnel working for or with Beth El Congregation and/or the Spiegel Religious School responsible for any injury that may occur to my child/children.
(Please enter your initials or name in the box below to indicate you are giving permission as stated above).

* Parental Consent for Child/Children to Participate in Physical Activities

By typing my name or inserting my initials, I confirm I have read, understand and agree to the above.

Media Release

Permission for Pictures

I, as a parent or legal guardian of my child/children listed in this registration form, give my permission for Beth El Congregation and/or Spiegel Religious School to include the photo, likeness, video, and/or audio of my child/children listed in this registration form in any/all of the following media/formats: 1) The Beth El website; 2) Email Blasts/Updates; 3) The Kol Newsletter; and 4) The Jewish Chronicle
(Please enter your initials or name in the box below to indicate you are giving permission as stated above).

* Permission for Pictures

By typing my name or inserting my initials, I confirm I have read, understand and agree to the above.