2023-2024 Tiny Torahs Registration - Form - Beth El Congregation of the South Hills

Playtime for Ages Birth to 3 and Me!

(Mom, Dad, Grandma, Grandpa, etc!)

Connecting with other young families
Visits with the Rabbis
Crafts
Music
Gross motor activity fun
Snacks & so much more!

Questions:
email Rabbi Amy Greenbaum or call 412-561-1168

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)

* May we text you? (Parent #1)

Please Select OneYesNo

* Street Address (Parent #1)

Street Address Line 2 (Parent #1)

* City (Parent #1)

* State (Parent #1)

* ZIP (Parent #1)

* How many Tiny Torahs children are being enrolled for the upcoming school year?

Please Select One1 child2 children

* 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)

* Cell Phone (Parent #2)

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

* May we text you? (Parent #2)

Please Select OneYesNo

* Street Address (Parent #2)

Street Address Line 2 (Parent #2)

* City (Parent #2)

* State (Parent #2)

* ZIP (Parent #2)

Emergency Contacts (other than Parent)

* Emergency Contact Name (Primary)

* Emergency Contact Cell Phone (Primary)

* Emergency Contact Relationship (Primary)

* Emergency Contact Name (Secondary)

* Emergency Contact Cell 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 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 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.

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.