2017-18 BJEP Student Registration Form
Thank you for taking the time to read and complete this form. This information helps us to create a successful program for our students and streamlines our payment process. We hope it saves you some time and energy too!
Are you a new family joining BJEP?
Last Name *
If there is more than one last name in your family, please indicate the last name of your child(ren).
Your answer
Student #1 First Name *
Your answer
Student #1 Gender *
Your answer
Student #1 Date of Birth *
MM
/
DD
/
YYYY
Student #1 Grade *
Please enter the grade your child will be in for the 2017-2018 school year.
Your answer
Student #1 Allergy Information
Please list allergies here. (Food, and any other allergies that may require the use of an Epi Pen)
Your answer
Student #1 Email Address
This question is only required for Teen Madrichim. BJEP will cc parents when communicating with their Madrichim.
Your answer
Student #1 Friend Request
Use the space below to write the name(s) of up to 2 friends whom your child would like to have in his or her classroom. We will do our best to accommodate requests, but cannot guarantee them.
Your answer
Student #2 First Name
Your answer
Student #2 Gender
Your answer
Student #2 Date of Birth
MM
/
DD
/
YYYY
Student #2 Grade
Please enter the grade your child will be in for the 2017-2018 school year.
Your answer
Student #2 Allergy Information
Please list allergies here. (Food, and any other allergies that may require the use of an Epi Pen)
Your answer
Student #2 Email Address
This question is only required for Teen Madrichim. BJEP will cc parents when communicating with their Madrichim.
Your answer
Student #2 Friend Request
Use the space below to write the name(s) of up to 2 friends whom your child would like to have in his or her classroom. We will do our best to accommodate requests, but cannot guarantee them.
Your answer
Student #3 First Name
Your answer
Student #3 Gender
Your answer
Student #3 Date of Birth
MM
/
DD
/
YYYY
Student #3 Grade
Please enter the grade your child will be in for the 2017-2018 school year.
Your answer
Student #3 Allergy Information
Please list allergies here. (Food, and any other allergies that may require the use of an Epi Pen)
Your answer
Student #3 Email Address
This question is only required for Teen Madrichim. BJEP will cc parents when communicating with their Madrichim.
Your answer
Student #3 Friend Request
Use the space below to write the name(s) of up to 2 friends whom your child would like to have in his or her classroom. We will do our best to accommodate requests, but cannot guarantee them.
Your answer
Bar or Bat Mitzvah Date & student's name(s), if known
We'd love to annouce your Simcha (joys occasion) in our email newsletter. If your son or daughter has an upcoming Bar/Bat Mitzvah please list their name(s) and the date.
Your answer
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