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BI Auxiliary
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2019-2020 Talmud Torah Form
Family Name
Address
City
Postal Code
Home Phone
How many parents on this account?
Please Select One
One Parent
Two Parents
Adult 1 - First Name
Adult 1 - Last Name
Adult 1 - Hebrew Name
Adult 1 - Email Address
Adult 1 - Cell Phone
Adult 1 - Work Phone
Adult 2 - First Name
Adult 2 - Last Name
Adult 2 - Hebrew Name
Adult 2 - Email Address
Adult 2 - Cell Phone
Adult 2 - Work Phone
Does Adult 2 live at the same address?
Please Select One
Yes
No
Adult 2 - Address
Adult 2 - City
Adult 2 - Postal Code
How many students are you registering?
Please Select One
1
2
3
Student One Information
First Name
Last Name
Middle Name
Hebrew Name
Nick Name
Student - Gender
N/A or Unknown
Male
Female
Student - Birthdate
Language(s) spoken at home
English
Hebrew
French
German
Russian
Yiddish
Other
Does you child have allergy or dietary restrictions
Please Select One
Yes
No
If yes, please describe in further detail about the allergy(ies), reactions, and procedures to be followed.
Has your child been vaccinated?
Please Select One
Yes
No
If No, please state reason:
Do you have proof of exemption?
Please Select One
Yes
No
Disclaimer:
Your child/ren's enrollment will be subject to evaluation by the Parent Committe.
Does you child carry an Epipen?
Please Select One
Yes
No
If you child requires and Epipen, please indicate where the Epipen is located (on the student, where in their bag, etc.) and ensure the student and your child's teacher is aware of this. We highly recommend the Epipen be carried on the student (and that the student wear and allergy bracelet or necklace).
Are there any emotional or physical health issues that BETT staff should know?
Please Select One
Yes
No
If yes, please describe these issues and explain how they affect class time:
Does your child have an Individualized Education Plan (iep) at school?
Please Select One
Yes
No
These strategies are useful to teachers. Please upload a copy of your child's iep in the box below or bring a copy of the report to Talmud Torah.
Is there anything else about your child that we should know?
Please Select One
Yes
No
BETT receives grant funding from the Limestone District School Board. In order to receive this funding, we need the following information about your child:
Child's Public School
Grade in 2019/2020
OEN - Child's Student Number
This is a 9 digit number found on your child's report card
Student Two Information
First Name
Last Name
Middle Name
Hebrew Name
Nick Name
Student - Gender
N/A or Unknown
Male
Female
Student - Birthdate
Language(s) spoken at home
English
Hebrew
French
German
Russian
Yiddish
Other
Does you child have allergy or dietary restrictions
Please Select One
Yes
No
If yes, please describe in further detail about the allergy(ies), reactions, and procedures to be followed.
Has your child been vaccinated?
Please Select One
Yes
No
If No, please state reason:
If you child requires and Epipen, please indicate where the Epipen is located (on the student, where in their bag, etc.) and ensure the student and your child's teacher is aware of this. We highly recommend the Epipen be carried on the student (and that the student wear and allergy bracelet or necklace).
Disclaimer:
Your child/ren's enrollment will be subject to evaluation by the Parent Committee.
Does you child carry an Epipen?
Please Select One
Yes
No
If you child requires and Epipen, please indicate where the Epipen is located (on the student, where in their bag, etc.) and ensure the student and your child's teacher is aware of this. We highly recommend the Epipen be carried on the student (and that the student wear and allergy bracelet or necklace).
Are there any emotional or physical health issues that BETT staff should know?
Please Select One
Yes
No
If yes, please describe these issues and explain how they affect class time:
Does your child have an Individualized Education Plan (iep) at school?
Please Select One
Yes
No
These strategies are useful to teachers. Please upload a copy of your child's iep in the box below or bring a copy of the report to Talmud Torah.
Is there anything else about your child that we should know?
Please Select One
Yes
No
BETT receives grant funding from the Limestone District School Board. In order to receive this funding, we need the following information about your child:
Child's Public School
Grade in 2019/2020
OEN - Child's Student Number
This is a 9 digit number found on your child's report card
Student Three Information
First Name
Last Name
Middle Name
Hebrew Name
Nick Name
Student - Gender
N/A or Unknown
Male
Female
Student - Birthdate
Language(s) spoken at home
English
Hebrew
French
German
Russian
Yiddish
Other
Does you child have allergy or dietary restrictions
Please Select One
Yes
No
If yes, please describe in further detail about the allergy(ies), reactions, and procedures to be followed.
Has your child been vaccinated?
Please Select One
Yes
No
If No, please state reason:
Do you have proof of exemption?
Please Select One
Yes
No
Disclaimer:
Your child/ren's enrollment will be subject to evaluation by the Parent Committee.
Does you child carry an Epipen?
Please Select One
Yes
No
If you child requires and Epipen, please indicate where the Epipen is located (on the student, where in their bag, etc.) and ensure the student and your child's teacher is aware of this. We highly recommend the Epipen be carried on the student (and that the student wear and allergy bracelet or necklace).
Are there any emotional or physical health issues that BETT staff should know?
Please Select One
Yes
No
If yes, please describe these issues and explain how they affect class time:
Does your child have an Individualized Education Plan (iep) at school?
Please Select One
Yes
No
These strategies are useful to teachers. Please upload a copy of your child's iep in the box below or bring a copy of the report to Talmud Torah.
Is there anything else about your child that we should know?
Please Select One
Yes
No
BETT receives grant funding from the Limestone District School Board. In order to receive this funding, we need the following information about your child:
Child's Public School
Grade in 2019/2020
OEN - Child's Student Number
This is a 9 digit number found on your child's report card
Emergency Contact - Name
Emergency Contact - Relationship
Emergency Contact - Phone
Emergency Contact - Name
Emergency Contact - Relationship
Emergency Contact - Phone
Important Notes:
Should you wish to discuss your child and his/her needs more thoroughly, please contact Rabbi Polansky or the Parent Committee Chair.
If the status of your child's health changes (ie medication, allergies, etc.) please notify Beth Israel Talmud Torah as asoon as possible.
Supervision begins at 3:45pm on Wednesdays. If your child will need to be dropped off earlier, please advise.
*
Media Release
Please Select One
Yes I agree
No I do not agree
PHOTO/VIDEO RELEASE:
I acknowledge that Kingston Beth Israel is responsible for producing and publishing a variety of newsletters, brochures, videos, flyers and social media publicity. I hereby authorize KBI to use, reproduce or publish photographs or videos of my child/children or of me which may be taken during our participation in religious school and educational activities for any purposes without compensation to me or my child/children.
Sun, 15 September 2019 15 Elul 5779
