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REGISTRATION FORM

Jewish Family Experience Delray

Beit Mishpacha

2025 - 2026 Registration

Please complete each item on this form.

Date of Birth
Month
Day
Year
Prior Religious Instruction
Yes
No

Family Contact Information

Parent 1/ Guardian Information:

Can Parent 1/ Guardian recieve info via text?
Yes
No
Multi-line address
Marital Status
Married
Divorced
Separate
Single

Parent 2/ Guardian Information

Multi-line address
Can Parent 2/ Guardian recieve info via text?
Yes
No
Marital Status
Married
Divorced
Separate
Single
Child lives with
Both Parents
Mother
Father
Other
Is there a Court Order barring either parent form removing the student from Jewish Family Experience, Beit Mishpaca?
Yes
No
Do the parents have shared (joint) parental rights and responsibility?
Yes
No
Is there a Temporary Restraining Order, Permanent Order, Order of No Contact , Or other Court that restricts or impacts access to the student by anyone, including a parents/ guardian?
Yes
No

Please provide Jewish Family Experience, Beit Mishpacha with a copy of ANY applicable court orders.

Primary Emergency Contact

Other than parents, must be reachable during Jewish Family Experience, Beit Mishpacha Hours

Secondary Emergency Contact

Other than parents, must be reachable during Jewish Family Experience, Beit Mishpacha Hours

Imprtant Information

I give permission for my child to be photographed and video recorded during school events, on or off campus. Permission is granted for use of photo and likeness for promotional and/or archival purposes by any means and at the discretion of Jewish Family Experience, Beit Moshpacha without compensation. I also give permission for these pictures to be used and posted to any social media site by any representative of the above-named situations.

  • In the event of an emergency, if I'm unable to be contacted, I grant permission to Jewish Family Experience, Beit Mishpacha, program to authorize any emergency action necessary to ensure the safety of my child. I agree to liable and to pay for all costs and expenses incurred in connection with any services provided (e.g. medical or dental services).

  • I give permission for my child to attend all Jewish Family Experience, Beit Mishpacha program field trips, unless otherwise indicated in writing prior to the event.


  • I agree to read the Jewish Family Experience, Beit Mishpacha manual (to be provided to me) and I agree that I am all members of my family will abide by all the policies and stated therien.

  • I agree to read and sign, together with my child, the family Code of Conduct (to be provided to me) and I agree that I am all members of my family will abide by the items stated therien.

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Date
Month
Day
Year

Prefer paper? click the PDF file below to download the registration form. Once completed, you can return it by email to info@jewishfamilyexperiencedelray.org,

bring it in person, or mail to us.

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