Beit Sefer Phyllis Mintzer 2022-2023 School Year Registration

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Student 1

* Student 1: Name

Student's Hebrew Name (if applicable)

* Birthdate

* Gender

* Grade in Fall 2022

* Name of Public or Private School

If you are new to Beit Sefer, please upload proof of vaccination

Student 2

Student 2: Name

Student's Hebrew Name (if applicable)

Birthdate

Gender

Grade in Fall 2022

Name of Public or Private School

If you are new to Beit Sefer, please upload proof of vaccination

Student 3

Student 3: Name

Student's Hebrew Name (if applicable)

Birthdate

Gender

Grade in Fall 2022

Name of Public or Private School

If you are new to Beit Sefer, please upload proof of vaccination

Parent 1

* First Name

* Last Name

* Email

* Gender

* Primary Phone

Secondary Phone

* Street Address

Address Line 2

* City

* State

* Zip Code

If you are new to Beit Sefer, please upload proof of vaccination

Parent 2

First Name

Last Name

Gender

Primary Phone

Secondary Phone

Street Address

Address Line 2

City

State

Zip

If you are new to Beit Sefer, please upload proof of vaccination

Parent 3

First Name

Last Name

Gender

Primary Phone

Secondary Phone

Street Address

Address Line 2

City

State

Zip

If you are new to Beit Sefer, please upload proof of vaccination

Medical and Emergency Information

Emergency Information
Person other than parent to contact in case of emergency (mandatory to list at least one, two is better!)

* First Name

* Last Name

* Relationship

* Phone

First Name

Last Name

Relationship

Phone

Medical Information

* Physician's Full Name

* Physician's Phone

* Health Insurance Company

* Policy Number

* Re-type Policy Number

Does your child have life threatening allergies or other important medical information you would like us to be aware of?

* If so, please state the name of the child you are referring to and provide a description in the space provided. If not, please type "No" or N/A"

Medical Consent

* I, the undersigned, authorize Sha’ar Zahav to call a physician or seek emergency room treatment as necessary for any of my children in case of any medical emergency and agree to pay all expenses incurred. (This authorization is given pursuant to the provisions of section 25.8 of the Civil Code of the State of California)

Please Select OneYes

Field Trip Permission

* I authorize my child(ren) to attend all planned trips arranged by youth education programs at Congregation Sha’ar Zahav, and release Sha’ar Zahav, its officers, agents and employees from any and all liability arising out of my child’s participation in such activity.

Please Select OneYesNo

Photograph Consent

* Occasionally photos of your student might be included on our website or other Sha’ar Zahav/Beit Sefer Phyllis Mintzer printed publications. Images will never include any name or other identifying information. Please sign in the space below to give us your consent to publish in print, electronic, or video format the likeness or image of your child(ren)

Please Select OneYesNo

Enrollment Agreement

* I understand that I am committing to my child's enrollment in Beit Sefer Phyllis Mintzer for the 2022-2023 school year. I also understand that in order to enroll children in 4th grade and higher, a family commitment to membership is required. I agree to make a membership contribution/"gift of the heart" along with paying the tuition below. There are no refunds on school tuition.

Please Select OneYes

Payment

BSPM Tuition for Shabbat School Year 2022-2023 (Grades K-7)
$1,005.00 Per Student

Hebrew Tutoring for School Year 2022-2023 (Grades 5 & 6 ONLY)
$310.00 Per Student

B'mitzvah Fee (Grade 7 ONLY)
$515.00 Per Student

If you wish to pay in installments, you will be prompted to choose the frequency of payments after clicking "Submit"

Please list the quantity (number of children) you wish to enroll for each program, below.

* BSPM 2022-2023 School Year Tuition

Shabbat School for 2022-2023 (Grades K-7)

Hebrew Tutoring for 2022-2023 (Grades 5 & 6 only)

B' Mitzvah Fee (Grade 7 only)

Scholarship

If you require a scholarship, please select the scholarship option only.
A scholarship form will be sent to you; you will be billed after the scholarship is awarded.

Total

Sun, August 14 2022
17 Av 5782

Friday Night

Candle Lighting

: 8:16pm

Shabbat Day

Havdalah

: 9:24pm

This week's Torah portion is Parashat Chukat

Shabbat, Jul 9

Candle Lighting

Friday, Jul 8, 8:16pm

Havdalah

Motzei Shabbat, Jul 9, 9:24pm

Fast of Tammuz

Sunday, Jul 17

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Sun, August 14 2022 17 Av 5782