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To register print this form and turn it into the office at 403 N. Nova Road, Ormond Beach, FL 32174 Fax (386)672-6834 (highlight or select the text in the form below and then use the print button)




All registrations are due by Sunday, August 7, 2005

Note: 4th - B'nai Mitzvah meet______________, 6:15 - 7:30 pm at B'nai Torah beginning August 24th and Sundays, 9:30 am - 12:15 pm at Temple Israel during first semester beginning September 11th and B'nai Torah during second semester. K-3 meets from 9:30 - 12:15 on Sundays a Temple Israel for first semester beginning September 11th and B'nai Torah for second semester. Confirmation meets from 9:30 - 12:15 every other Sunday beginning September 11th. First semester is at Temple Israel and second semester is at Congregation B'nai Torah.

Student's Name:_______________________________________Date of Birth:___________________

Student's Hebrew Name:______________________________________________________________

Regular School Grade effective August 2005:______________________________________________

Parent's Name:_____________________________________________________________________

Mailing Address:____________________________________________________________________

Daytime Phone:___________________________Evening Phone:______________________________

Cell Phone:_______________________________Email:____________________________________

Emergency Contact Name, Relatioinship & Phone:__________________________________________



Parent Signature

NOTE: Submission of this form indicates that the parents agree to the current fee schedule, $300/student. Fees paid in full prior to October 22, 2005 are $300/1st student and $275/each additional student; otherwise all students are $300. Please make checks payable to Congregation B'nai Torah Religious School. All fees must be paid by April 17, 2006.