Beit Sefer Beth Hillel Registration
Please complete this form for each child that you intend to send to school.
Contact Rabbi Feingold or school administrator with questions.
Childs Name(*)
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Hebrew Name
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Birth date(*) / /
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Secular School Grade(*)
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Parent(s) Name(s)(*)
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Home Phone (xxx-xxx-xxxx)
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Cell Phone (xxx-xxx-xxxx)
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email address(*)
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Emergency Contact Name(*)
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Emergency Phone Number (xxx-xxx-xxxx)(*)
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Interested in carpooling?
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Community carpooling from
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Please list below food allergies, medical conditions, or other special needs your child may have,
pertaining to her/his educational experience at our school. If your child has an IEP that we should
be aware of, please make sure the school administrator receives a copy.
Special Needs
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Emergency Contacts and Insurance Info:
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Doctor's phone
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Dentist's phone
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Insurance provider(*)
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Policy number(*)
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BSBH Programs:
Sunday Religious School (9:30-Noon; starts Sept. TBA). Children entering Kindergarten thru 9th grade.
Wednesday Hebrew (5:30-7:15pm; starts Sept. TBA
). Children entering grades 3-7 or children who will be 8 yrs old by January 1, 2018.
Confirmation (Meeting time TBA). 10th Grade.
Bar/Bat Mitzvah
Temple Tots (Monthly). Children 4 years and under. Must be accompanied by an adult.
Select program
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Beit Sefer Beth Hillel is funded primarily by the tuition paid by the families with enrolled children. Scholarships
are available to ensure every child has an opportunity for a Jewish education. Please contact the Religious
school administrator at for further information.

Permission for a photo/image that includes this student to be published in the Achshav, school E-Tone,
website and/or other publicity materials.

As you are aware, there are potential dangers associated with the posting of personally identifiable
information on a web site since global access to the Internet does not allow us to control who may access
such information. These dangers have always existed; however, we do want to celebrate your child and his/her
work. The law requires that we ask for your permission to use information about your child.

Pursuant to law, we will not release any personally identifiable information without prior written consent
from you as parent or guardian. Personally identifiable information includes student names and photo or image.
Regardless of your choice below, Temple policy prohibits the display of photos of minor children in
publicly accessible materials directly identified with their name.

If you, as the parent or guardian, wish to rescind this agreement, you may do so at any time in writing by
sending a letter to your child’s school and such rescission will take effect upon receipt by the school.
Photo release(*)
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August FOOD OF THE MONTH: Graham Crackers 

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