B'Yachad Registration 24-25 - Form - B'Yachad School Springfield

CAREGIVER INFORMATION - Please sign in to your account before starting this form.

* Caregiver First Name

* Caregiver Last Name

* Caregiver Email

* Cell Phone

Add additional caregivers?

SECOND CAREGIVER INFORMATION

Caregiver 2 First Name

Caregiver 2 Last Name

Caregiver 2 Email

Caregiver 2 Cell Phone

THIRD CAREGIVER INFORMATION

Caregiver 3 First Name

Caregiver 3 Last Name

Caregiver 3 Email

Caregiver 3 Cell Phone

FOURTH CAREGIVER INFORMATION

Caregiver 4 First Name

Caregiver 4 Last Name

Caregiver 4 Email

Caregiver 4 Cell Phone

ADDRESS INFORMATION

* Street

* City

* State

* Zip

SYNAGOGUE AFFILIATION

B'Yachad is subsidized by Temple Beth El and Sinai Temple. All are welcome in our learning community,
however, an additional $360 per student will be collected from unaffiliated households.

* Do you belong to a local synagogue?

Name of Synagogue:

CHILD INFORMATION

* How many children are you registering

CHILD 1

Child 1 First Name:

Child 1 Last Name:

Child 1 Nickname:

* Child 1 Grade (Fall 2024)

Child 1 DOB

Child 1 Hebrew Name

Child 1 Prounouns

Preferred Pronouns:

Child 1 Dietary Needs

KosherVegetarianVeganGluten Free

Child 1 Allergies and/or Medical Conditions:

Child 1 Learning Needs:

Please share anything we should know about your child in the classroom setting:

If the content/guidelines in your child's IEP or 504 Plan would improve their experience in B'yachad, please upload it here.

CHILD 1 TUITION INFORMATION

B'Yachad Community Religious School tuition is based on a sliding-scale model.
If you are not able to pay the minimum amount due to financial hardship please check the box below indicating your need for scholarship and someone from B'Yachad will follow up with you.

* Please select grade for Child 1

* Child 1 Tuition

I am unable to meet the minimum contribution. I will compete the online Scholarship Registration Form by Oct 1.

I am unable to meet the minimum contribution. I will compete the online Scholarship Registration Form by Oct 1. Online Scholarship Request Form

CHILD 2

Child 2 First Name:

Child 2 Last Name:

Child 2 Nickname:

* Child 2 Grade (Fall 2024)

Child 2 DOB

Child 2 Hebrew Name

Child 2 Prounouns

Preferred Pronouns:

Child 2 Dietary Needs

KosherVegetarianVeganGluten Free

Child 2 Allergies and/or Medical Conditions:

Child 2 Learning Needs:

Please share anything we should know about your child in the classroom setting:

If the content/guidelines in your child's IEP or 504 Plan would improve their experience in B'yachad, please upload it here.

CHILD 2 TUITION INFORMATION

* Please select grade for Child 2

* Child 2 Tuition

I am unable to meet the minimum contribution. I will complete the online scholarship request form by Oct 1.

CHILD 3

Child 3 First Name:

Child 3 Last Name:

Child 3 Nickname

* Child 3 Grade (Fall 2024)

Child 3 DOB

Child 3 Hebrew Name

Child 3 Prounouns

Preferred Pronouns:

Child 3 Dietary Needs

KosherVegetarianVeganGluten Free

Child 3 Allergies and/or Medical Conditions:

Child 3 Learning Needs:

Please share anything we should know about your child in the classroom setting:

If the content/guidelines in your child's IEP or 504 Plan would improve their experience in B'yachad, please upload it here.

CHILD 3 TUITION INFORMATION

* Please select grade for Child 3

* Child 3 Tuition

I am unable to meet the minimum contribution. I will complete the online scholarship application form by Oct 1.

I am unable to meet the minimum contribution. I will complete the online scholarship application form by Oct 1.Online Scholarship Request Form

CHILD 4

Child 4 First Name:

Child 4 Last Name:

Child 4 Nickname

* Child 4 Grade (Fall 2024)

Child 4 DOB

Child 4 Hebrew Name

Child 4 Prounouns

Preferred Pronouns:

Child 4 Dietary Needs

KosherVegetarianVeganGluten Free

Child 4 Allergies and/or Medical Conditions:

Child 4 Learning Needs:

Please share anything we should know about your child in the classroom setting:

If the content/guidelines in your child's IEP or 504 Plan would improve their experience in B'yachad, please upload it here.

CHILD 4 TUITION INFORMATION

* Please select grade for Child 4

* Child 4 Tuition

I am unable to meet the minimum contribution. I will complete the online scholarship request form by Oct 1.

I am unable to meet the minimum contribution. I will complete the online scholarship request form by Oct 1.Online Scholarship Request Form

CHILD 5

Child 5 First Name:

Child 5 Last Name:

Child 5 Nickname:

* Child 5 Grade (Fall 2024)

Child 5 DOB

Child 5 Hebrew Name

Child 5 Prounouns

Preferred Pronouns:

Child 5 Dietary Needs

KosherVegetarianVeganGluten Free

Child 5 Allergies and/or Medical Conditions:

Child 5 Learning Needs:

Please share anything we should know about your child in the classroom setting:

If the content/guidelines in your child's IEP or 504 Plan would improve their experience in B'yachad, please upload it here.

CHILD 5 TUITION INFORMATION

* Please select grade for Child 5

* Child 5 Tuition

I am unable to meet the minimum contribution. I will complete the online scholarship request form by Oct 1.

I am unable to meet the minimum contribution. I will complete the online scholarship request form by Oct 1.Online Scholarship Request Form

RELEASE FORMS

* In an effort to foster connections among B'Yachad families and strengthen the bonds of our community, contact information for enrolled families may be periodically distributed among B'Yachad families.

Please Select OneI grant permission for contact information from my household to be shared with other B'Yachad households.Please do not share any contact information for my households with other B'Yachad households.

* From time to time your child's photo may be taken in our classrooms or at special events. We use these photos in our newsletters, on our website, in our Facebook posts, and in other publicity materials.

Please Select OneI grant permission for my child(ren)'s image to be used in all media material.I do not grant permission for my child(ren)'s image to be used in any media material.

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