Temple Beth Zion
1566 Beacon Street
Brookline, MA 02446
617.566.8171

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Beit Rabban for Grades K-7 Sign Up

Beit Rabban 2011-2012 Registration Form

Wednesdays 4 to 6pm at Temple Beth Zion

Child's Name*
FirstLast
Hebrew Name
Gender*
- Male
- Female
Student Status*
- New Student
- Returning Student
Date of Birth*
Grade (as of Sep. 2011)*
School*
Street Address*
Street AddressAddress Line 2CityStateZip Code
Phone*
Child Lives With*
- Both Parents
- Parent 1
- Parent 2
Other (please explain)
Parents
Parent 1*
FirstLast
Email*
Work Phone
Cell Phone*
Occupation
Address (Complete if different from student's above)
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Parent 2
FirstLast
Email
Work Phone
CellPhone
Address (Complete if different from student's above)
Street AddressAddress Line 2CityState / Province / RegionZip / Postal CodeCountry
Emergency Contact Information
Name*
FirstLast
Relation*
Phone*
Email
Student Questions
1. Has your child received in the past any formal Jewish education? *
- Yes
- No
Please write where and for how long, even if it was at TBZ.
2. If your child learned Hebrew in the past, please specify how many years, what level you think your child is at (e.g., recognizes letters, is able to read, has a basic vocabulary, knows present/past/future tenses, etc.). This information will help us to organize the groups by levels. If necessary, we will reassess students at the beginning of the year.
3. What does Judaism look like in your home? (Do you celebrate Shabbat at home? Other holidays?)
4. What is your child’s relationship to Judaism? (Goes to Jewish camp? Is interested in learning and asking questions about being Jewish?)
5. Please describe the student’s attitude towards Beit Rabban.
6. Does the student have any learning issues?
- Yes
- No
If so, please describe.
7. Please list all existing medical conditions of special concern (including allergies to medication and food)
8. Does the student have any emotional or familial issues of which we should be aware?
- Yes
- No
If so, please describe.
9. In every class, there is a parent liaison. This is not a major time commitment. It involves coordinating a snack rotation at the beginning of the year and following up with any changes or adjustments during the year. Are you willing to be the parent liaison?
- Yes
- No
10. In case of emergency, to you give permission for employees of Temple Beth Zion to call 911 for your child?
- Yes
- No
11. Occasionally, we may want to take a class to Driscoll Park, Summit Park, Shaw’s or somewhere within walking distance. Do we have your permission with advance notice from the teacher?
- Yes
- No
12. Please add any other comments or information.
Signature of Parent
- Yes

Beit Rabban Handbook 2011-12

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