2021 Beit Sefer Chayim Enrolment Term 1 - Form

Beit Sefer Chayim 2021 - Enrollment Form

Synagogue Membership

Temple Beth Israel (TBI) MembersEtz Chayim Progressive Synagogue MembersOur family are not members of either congregation

* Is your family new to our school?

Please Select OneNoYes

If you have attended TBI Tamid or Beit Sefer Chayim/UJEB at Etz Chayim in the past, please select no.

Section A: Family Contact Information

Please complete the follow details for the primary parent/guardian contact

* First Name (Primary)

* Last Name (Primary)

* Email (Primary)

* Mobile (Primary)

* Relationship to Student(s) (Primary)

* Street Address (Primary)

Street Address Line 2 (Primary)

* City (Primary)

* State (Primary)

* Post Code (Primary)

Are there any legal matters we should be aware of? Custody arrangements etc?

YesNo

If yes, please specify:

* Is there a secondary parent/guardian 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)

* Mobile (Secondary)

* Relationship to Student(s) (Secondary)

* Street Address (Secondary)

Street Address Line 2 (Secondary)

* City (Secondary)

* State (Secondary)

* Postcode (Secondary)

Section B: Emergency Contact Details

* Emergency Contact Name

* Emergency Contact Phone

* Emergency Contact Relationship

Section C: Student Enrollment Information

Student 1 Information

* Student 1 First Name

* Student 1 Last Name

Student 1 Nickname (if applicable)

* Student 1 Hebrew Name

* Student 1 Birthdate

Student 1 Email (if applicable)

Information will not be shared publicly. Parents/Guardians 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/guardians.

* Student 1 Grade level at school

Student 1 Primary School name

Attendance at Beit Sefer Chayim

St Kilda - Tuesdays 4-6pmBentleigh - Wednesdays 4.30-6.30pm

Learning Needs

Please describe any specific learning needs for your child. If you wish to discuss your child's needs, please contact Tammy Cohen, tammy.cohen@tbi.org.au

* Student 1 Allergies or Medications

Please Select OneNoYesDoes 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 Nickname (if applicable)

* Student 2 Hebrew Name

* Student 2 Birthdate

Student 2 Email (if applicable)

Information will not be shared publicly. Parents/Guardians 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/guardians.

Student 2 Grade Level at School

* Student 2 Primary School Name

Attendance at Beit Sefer Chayim

St Kilda - Tuesdays 4-6pmBentleigh - Wednesdays 4.30-6.30pm

Learning Needs

Please describe any specific learning needs for your child. If you wish to discuss your child's needs, please contact Tammy Cohen, tammy.cohen@tbi.org.au

* Student 2 Allergies or Medications

Please Select OneNoYesDoes 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 Nickname (if applicable)

* Student 3 Hebrew Name

* Student 3 Birthdate

Student 3 Email (if applicable)

Information will not be shared publicly. Parents/guardians 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/guardians.

Student 3 Grade Level at School

* Student 3 Primary School Name

Attendance at Beit Sefer Chayim

St Kilda - Tuesdays 4-6pmBentleigh - Wednesdays 4.30-6.30pm

Learning Needs

Please describe any specific learning needs for your child. If you wish to discuss your child's needs, please contact Tammy Cohen, tammy.cohen@tbi.org.au

* Student 3 Allergies or Medications

Please Select OneNoYesDoes 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 Nickname (if applicable)

* Student 4 Hebrew Name

* Student 4 Birthdate

Student 4 Email (if applicable)

Information will not be shared publicly. Parents/guardians 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/guardians.

* Student 4 Grade Level at School

* Student 4 Primary School Name

Attendance at Beit Sefer Chayim

St Kilda - Tuesdays 4-6pmBentleigh - Wednesdays 4.30-6.30pm

Learning Needs

Please describe any specific learning needs for your child. If you wish to discuss your child's needs, please contact Tammy Cohen, tammy.cohen@tbi.org.au

* Student 4 Allergies or Medications

Please Select OneNoYesDoes 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 D: Media Release

From time to time your child’s photo may be taken during our programs, services and special events. We use these photos in the synagogue newsletters, on our synagogues websites as well as our Facebook groups and other publicity materials.

* Media Release

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

Section E: Payment Information

Tuition Fees

TBI Member Tuition Fees ($220/term, per student)

TBI Non-Member Tuition Fees ($270/term, per student)

Etz Chayim Member Tuition Fees ($220/term, per student)

Etz Chayim Non-Member Tuition Fees ($270/term, per student)Tuition fees for TBI or Etz Chayim Members is $220 per term, per student
Tuition fees for Non-Members of either congregation are $270 per term, per student

Total Tuition Fees

Term 1, 2021 Tuition fees are required to confirm enrolment.
Subsequent tuition will be billed at the beginning of each term.