Bar/Bat Mitzvah Program Orientation

STUDENT INFORMATION

Student's Full Name

Student's Hebrew Name

Birth Date

Gender Identity

Address

Phone Number

City

Province

Postal

Please list any disabilities, allergies, etc.:

PARENT/GUARDIAN CONTACT INFORMATION

Name of Parent/Guardian #1

Relationship to student

Lives with studentGuardianCustody

Home Phone

Cell Phone

Home Phone

Cell Phone

Name

Relationship to student

PARENT PERMISSION FOR THE USE OF IMAGES
Any changes to the permission granted on this form must be received in writing or emailed to the Education Director at schooldirector@beby.org

Occasionally, photos of students are included on our school and synagogue website, the BEBY Facebook page and other BEBY/Aleph Beit Chadash social media platforms. We WILL NOT include the name of your child or “tag” them in the picture. Please check one:

YES, BEBY and Aleph Beit Chadash have permission to use images of mychild on the BEBY and the Aleph Beith Chadash websites and social media pages.NO, BEBY and Aleph Beit Chadash DO NOT have permission to use imagesof my child on the BEBY and the Aleph Beith Chadash websites and social mediapages.

Do you give consent to share your contact information with other parents of children attending ABC or shul members for the purpose of carpooling/socializing?

YesNo

If yes, which is the best number to reach you?

Payment options

Beth Emeth MemberNon Member having their Bar/Bat Mitzvah at Beth Emeth $100Non Member NOT having their Bar/Bat Mitzvah at Beth Emeth $150

Total amount to be billed

Tuesday, 29 October, 2024 • 27 Tishrei 5785