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BSA REGISTRATION

BSA REGISTRATION2024-06-19T23:01:53+00:00

Registration Dates:

March 1-April 1 & April 15-may 15.

Registration Fee:

The registration fee will be $275 per child

Returning students are $200 per child

Click to Pay

Students Information

Child #1

Full Legal English Name of Child: *

Full Hebrew Name of Child (please spell in Hebrew): *

Name Child is called by:

Child’s Age:

English Birth date

Hebrew Birth date

Child #2

Full Legal English Name of Child:

Full Hebrew Name of Child (please spell in Hebrew):

Name Child is called by:

Child’s Age:

English Birth date

Hebrew Birth date

Child #3

Full Legal English Name of Child:

Full Hebrew Name of Child (please spell in Hebrew):

Name Child is called by:

Child’s Age:

English Birth date

Hebrew Birth date

Child #4

Full Legal English Name of Child:

Full Hebrew Name of Child (please spell in Hebrew):

Name Child is called by:

Child’s Age:

English Birth date

Hebrew Birth date

Family Information

Father

Father’s full English name:

Father’s full Hebrew name:

Title

Dr.

Mr.

Rabbi

Occupation:

Name of Company

Phone #:

Home Address

Mother

Mother’s full English name:

Mother’s full Hebrew name:

Title

Dr.

Mrs.

Ms.

Occupation:

Name of Company

Phone #:

Home Address

Grandparents

Paternal Grandparents’ Full English Names:

Paternal Grandparents’ Full Hebrew Names:

Phone #:

Home Address

Maternal Grandparents’ Full English Names:

Maternal Grandparents’ Full Hebrew Names:

Phone #:

Home Address

Siblings

Please list any siblings who are not enrolling at BSA:

Name:

Age:

School Currently Attending:

Name:

Age:

School Currently Attending:

Name:

Age:

School Currently Attending:

Name:

Age:

School Currently Attending:

Name:

Age:

School Currently Attending:

Additional Information

1. Does the child(ren) have any medical or psychological conditions that the school would benefit from knowing during the application process?

Yes

If yes, please specify:

2. Has the student(s) received any educational, psychological, speech and language, or occupational assessments?

Yes

If yes, please include a copy of the assessment with this application.

Choose File

3. Has the student(s) received, or is he/she currently receiving, academic support?

Yes

If yes, please give details on a separate sheet of paper.

Choose File

4. What Playgroup / School is the applicant(s) currently attending?

Child #1

playgroup / school attending

grade

Child #2

playgroup / school attending

grade

Child #3

playgroup / school attending

grade

Child #4

playgroup / school attending

grade

5. Is either parent deceased, remarried, or divorced?

Yes

If yes, please explain and include paperwork:

Choose File

6. Were both the parents and the child born Jewish?

Yes

If no, please indicate present status (in case of conversion, certificates must accompany this application):

7. Is the child(ren) adopted?

Yes

8. Is either parent a step-parent?

Yes

9. Current Shul Affiliation & Name of Rav.

Emergency Contacts if parents cannot be reached **LOCAL CONTACTS ONLY**

Name #1

Phone #:

Name #2

Phone #:

Your child(ren)’s spot at BSA for 2024-2025 school year will only be reserved with a non-refundable DEPOSIT of $275 per student – due June 1.

The deposit will be applied towards the tuition of the student(s) being registered. Tuition rates are computed on an annual basis and no allowances are made for absence.

Thank you for your interest in Beth Shalom Academy! By enrolling your child(ren), you grant permission for your child(ren) to be photographed or video recorded for use by BSA for promotional purposes. They will not be distributed to any other organization without your express permission.

This application provides us with a release to communicate with any previous school or playgroup which your child(ren) has attended.

Father’s Signature

Date

Mother’s Signature

Date

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Get In Touch.

Beth Shalom Academy

1025 Vine St,
Scranton, PA 18510

(570) 866-2216

info@bethshalomacademy.com