YEP Family Registration Form 2024-2025
YEP Parents: Please fill out this registration form, including both family and individual student information. Your children are not registered for YEP until this form is received. If you have any questions or wish to discuss your child(ren)’s needs, please call Rabbi Rosenbaum at (860) 233-8215 x2330 or email hrosenbaum@cbict.org. We look forward to working with you and your family during the coming year.

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Email *
FAMILY INFORMATION
Family Name *
Address *
Home Phone # *
Parent/Guardian 1 Name *
Parent/Guardian 1 E-Mail *
Parent/Guardian 1 Cell Phone # *
Parent/Guardian 2 Name *
Parent/Guardian 2 E-Mail *
Parent/Guardian 2 Cell Phone # *
Emergency Contact Name (Other than a Parent/Guardian) *
Emergency Contact Phone # *
Emergency Contact - Relationship to Students *
We give permission for our child(ren)'s photograph to be used in publicity on behalf of Congregation Beth Israel. We understand that no identifying information will accompany the photo without our permission. *
Name of Person Filling Out Form *
Date *
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STUDENT 1 INFORMATION
Student 1 First Name *
Student 1 Date of Birth *
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DD
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Student 1 Grade - September 2024 *
Student 1 School Name *
Student 1 PREFERRED HEBREW OPTION (GRADES 3 TO 7 ONLY): Please check below the preferred format for your child's Hebrew instruction for 2024-2025. You will be asked to confirm this choice later in the spring. *
Student 1 - Please list ALLERGIES.
Student 1 - Please list PHYSICAL/EDUCATIONAL LIMITATIONS.
Student 1 - Other Information
STUDENT 2 INFORMATION
Student 2 First Name
Student 2 Date of Birth
MM
/
DD
/
YYYY
Student 2 Grade - September 2024
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Student 2 School Name
Student 2 PREFERRED HEBREW OPTION (GRADES 3 TO 7 ONLY): Please check below the preferred format for your child's Hebrew instruction for 2024-2025. You will be asked to confirm this choice later in the spring.
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Student 2 - Please list ALLERGIES.
Student 2 - Please list PHYSICAL/EDUCATIONAL LIMITATIONS.
Student 2 - Other Information
STUDENT 3 INFORMATION
Student 3 First Name
Student 3 Date of Birth
MM
/
DD
/
YYYY
Student 3 Grade - September 2024
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Student 3 School Name
Student 3 PREFERRED HEBREW OPTION (GRADES 3 TO 7 ONLY): Please check below the preferred format for your child's Hebrew instruction for 2024-2025. You will be asked to confirm this choice later in the spring.
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Student 3 - Please list ALLERGIES.
Student 3 - Please list PHYSICAL/EDUCATIONAL LIMITATIONS.
Student 3 - Other Information
STUDENT 4 INFORMATION
Student 4 First Name
Student 4 Date of Birth
MM
/
DD
/
YYYY
Student 4 Grade - September 2024
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Student 4 School Name
Student 4 PREFERRED HEBREW OPTION (GRADES 3 TO 7 ONLY): Please check below the preferred format for your child's Hebrew instruction for 2024-2025. You will be asked to confirm this choice later in the spring.
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Student 4 - Please list ALLERGIES.
Student 4 - Please list PHYSICAL/EDUCATIONAL LIMITATIONS.
Student 4 - Other Information
A copy of your responses will be emailed to the address you provided.
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