2024-2025 Beth Yam Religious School Registration - Form

* Is your family new to our school?

Please Select OneYesNo

* Are you enrolling as a member or a non-member family?

Please Select OneMemberNon-Member

Section A: Family Contact Information

* First Name (Primary)

* Last Name (Primary)

* Email (Primary)

* Phone (Primary)

* Relationship to Student(s) (Primary)

* Street Address (Primary)

Street Address Line 2 (Primary)

* City (Primary)

* State (Primary)

* ZIP (Primary)

* Is there a secondary contact?

Please Select OneNoYes, at the same address as the primary contactYes, but at a different address than the primary contactIf there is a secondary contact, all emails and mailings will go to both contacts. In case of urgent need, the primary contact will be notified first

* First Name (Secondary)

* Last Name (Secondary)

* Email (Secondary)

* Phone (Secondary)

* Relationship to Student(s) (Secondary)

* Street Address (Secondary)

Street Address Line 2 (Secondary)

* City (Secondary)

* State (Secondary)

* ZIP (Secondary)

* Emergency Contact Name

* Emergency Contact Phone

* Emergency Contact Relationship

Section B: Student Enrollment Information

Student 1 Information

* Student 1 First Name

* Student 1 Last Name

* Student 1 Birthdate

* Student 1 Gender Identification

Please Select OneFemaleMaleNonbinary or Other

* Student 1 Hebrew Name

Student 1 Nickname (if applicable)

Student 1 Grade in Secular School

* Student 1 Secular School Name

Class for Student 1

Kita Gan - 3 and 4 year olds - $540Aleph - Kindergarten and 1st Grade - $540Bet - 2nd and 3rd Grade - $540Gimel - 4th and 5th Grade - - $540Dalet - 6th and 7th Grade - $540Madrichim - B'nai Mitzvah Year - $318Lishmah - Post B'nai Mitzvah through 12th Grade - $318

Student 1 Email (if applicable)

Information will not be shared publicly. Parents will be copied on all communication to students.

Student 1 Phone (if applicable)

Information will not be shared publicly. Students will not be contacted independently from parents.

* Student 1 Special Learning Needs

Please Select OneNoYes (IEP or 504 or similiar)

* Student 1 Allergies or Medications

Does your child have allergies or medications we need to know about?

Student 1 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

Student 2 Information

* Student 2 First Name

* Student 2 Last Name

* Student 2 Birthdate

* Student 2 Gender Identification

Please Select OneFemaleMaleNonbinary or Other

* Student 2 Hebrew Name

Student 2 Nickname (if applicable)

* Student 2 Grade in Secular School

* Student 2 Secular School Name

Class for Student 2

Kita Gan- 3 and 4 year olds- $500Aleph- Kindergarten and 1st grade- $500Bet- 2nd and 3rd Grade- $500Gimel- 4th and 5th Grade- $500Dalet- 6th and 7th Grade- $500Madrichim- B'Nai Mitzvah Year- $278Lishmah- Post B'nai Mitzvah through 12th Grade- $278

Student 2 Email (if applicable)

Information will not be shared publicly. Parents will be copied on all communication to students.

Student 2 Phone (if applicable)

Information will not be shared publicly. Students will not be contacted independently from parents.

* Student 2 Special Learning Needs

Please Select OneNoYes (IEP or 504 or similiar)

* Student 2 Allergies or Medications

Does your child have allergies or medications we need to know about?

Student 2 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

Student 3 Information

* Student 3 First Name

* Student 3 Last Name

* Student 3 Birthdate

* Student 3 Gender Identification

Please Select OneFemaleMaleNonbinary or Other

* Student 3 Hebrew Name

Student 3 Nickname (if applicable)

* Student 3 Grade in Secular School

* Student 3 Secular School Name

Class for Student 3

Student 3 Email (if applicable)

Information will not be shared publicly. Parents will be copied on all communication to students.

Student 3 Phone (if applicable)

Information will not be shared publicly. Students will not be contacted independently from parents.

* Student 3 Special Learning Needs

Please Select OneNoYes (IEP or 504 or similiar)

* Student 3 Allergies or Medications

Does your child have allergies or medications we need to know about?

Student 3 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

Student 4 Information

* Student 4 First Name

* Student 4 Last Name

* Student 4 Birthdate

* Student 4 Gender Identification

Please Select OneFemaleMaleNonbinary or Other

* Student 4 Hebrew Name

Student 4 Nickname (if applicable)

* Student 4 Grade in Secular School

* Student 4 Secular School Name

Class for Student 4

Student 4 Email (if applicable)

Information will not be shared publicly. Parents will be copied on all communication to students.

Student 4 Phone (if applicable)

Information will not be shared publicly. Students will not be contacted independently from parents.

* Student 4 Special Learning Needs

Please Select OneNoYes (IEP or 504 or similiar)

* Student 4 Allergies or Medications

Does your child have allergies or medications we need to know about?

Student 4 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

Section C: Release Forms

By signing my name below, my child(ren) have permission to participate in Congregation Beth Yam Religious School. In consideration of my child(ren)'s acceptance as a religious school student, I hereby waive any and all claims against Beth Yam, its agents and its employees that may arise out of any injury, loss or damage suffered by my child(ren) during any religious school activity. I hereby authorize the Director of Jewish Youth Education or his/her designee to obtain emergency medical care for my child(ren) in the event such care is indicated. I give my permission for my child(ren) to receive emergency medical care by any nurse, doctor, paramedic or member of a medical staff of a hospital licensed by the State of South Carolina and/or the locality in which a Beth Yam-sponsored activity takes place. I understand that every effort will be made to notify a parent/guardian prior to treatment.

I certify that my child(ren) is(are) in good physical health. They have my permission to participate in all activities that are part of the regular religious school program. Field trips may be arranged by Beth Yam, and transportation may include bus or vehicle driven by a classmate's parent or guardian.

* Medical Release: Enter your name below

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

Media Release

From time to time your child’s photo may be taken in our classrooms or special events. We use these photos in the synagogue newsletters, on our synagogue website as well as our Facebook groups and other publicity materials. We will not identify students by name in any public posting or release.

* Media Release

Please Select OneI grant permission for my child's image to be usedI do not grant permission for my child’s image to be used

Section E: Payment Information

* Do you require financial aid?

Please Select OneNoYesThere are many impediments to Jewish education but finances should never be one. We ask that every family commits to some financial contribution, however we are happy to discuss financial aid options for synagogue members. If you select yes, you will discuss your payment ability in a confidential meeting with the Temple Treasurer.

Total Amount