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2024-2025 CBI Youth Education Student Information

Student Information Form for
Pre-K - 7th Grade Students

Parent/Guardian #1

Parent/Guardian #2

Student Information

Medical and Allergy Information
If your child has an Individualized Education Program (IEP) at secular school, please email a copy to so we can best support your child at religious school.

Medical and Allergy Information
If your child has an Individualized Education Program (IEP) at secular school, please email a copy to so we can best support your child at religious school.

Medical and Allergy Information
If your child has an Individualized Education Program (IEP) at secular school, please email a copy to so we can best support your child at religious school.


Please provide us with two Emergency Contacts to be notified if both parents/guardians are unreachable.

PARENTAL AGREEMENT AND RELEASE: I approve of the above registration for my child/ren. I understand that the Director of Education or another member of the temple staff will contact me in case of emergency. If I am going to be out of town, I will provide information as to how I can be reached in case of an emergency. I hereby grant permission for my child to be treated by qualified medical authorities as necessary, and I give permission to the Director to hospitalize, secure proper treatment, order injection, anesthesia or surgery for my child. I agree that we, our heirs, next of kin, guardians, successors and assigns or any other representative of ours will not sue, claim against, attach the property of or prosecute Congregation B’nai Israel or any of its directors, officers, agents and employees, and all affiliated entities for loss of property, injury, harm, accident, illness, loss of limb or life, or other personal injury, incapacity, medical cost, expense, damage, claim, liability, howsoever caused, and regardless of whether caused directly or indirectly, by their acts or any other acts, arising out of or in connection with the child’s participation in religious school and activities associated with CBI. The undersigned parent/guardian fully understands that s/he is responsible to pay all costs incurred as a result of the foregoing.

PHOTO/VIDEO RELEASE: I acknowledge that Congregation B’nai Israel is responsible for producing and publishing a variety of newsletters, brochures, videos, flyers and social media publicity. I also understand some educational sessions may take place online and be recorded. I hereby authorize CBI to use, reproduce or publish photographs or videos of my child/children or of me which may be taken during our participation in religious school and educational activities for any purposes without compensation to me or my child/children.

Congregation B’nai Israel Religious School and Youth Programs Policy Statement on Vaccine Status

The Talmud tells us that “all Israel are responsible for one another” (Shavuot 39a). At Congregation B’nai Israel, we believe that every member of our community has a responsibility not only for him or herself but for other members and the good of the community as a whole. This is true for many aspects of individual and community life, including our ability to keep members of the community healthy to the best of our ability.

In addition, among the highest Jewish values is Pikuach Nefesh – saving a life. The Central Conference of American Rabbis has stated “Jewish tradition would define immunization as part of the mitzvah of healing and recognize it as a required measure, since we are not entitled to endanger ourselves or the children for whom we are responsible... There are no valid Jewish religious grounds tosupport the refusal to immunize as a general principle.”

Each year, the American Academy of Pediatrics publishes a “Recommended Childhood and Adolescent Immunization Schedule.” Practicing pediatricians across North America consider this the standard of care and, indeed, the context in which they practice. In addition, the Centers for Disease Control (CDC) has established vaccine standards for adults. Given the overriding Jewish value that puts a premium on maintaining health, including taking preventive measures, along with the clear public health based need to protect the Congregation B’nai Israel, community as a whole, we expect that all children and staff be immunized in the manner below.

The vaccination of all members is essential in order to maintain a safe environment and decrease the risk of transmission of preventable illnesses, particularly to those who are unable to vaccinate due to age or medical contraindications. For Congregation B’nai Israel, and our parent organization, the Union for Reform Judaism (URJ), this is not an issue of individual rights and choice, but an issue of public health and policy. These guidelines are consistent with our community values and those of the URJ, as we strive to provide a safe, accessible place for all members of our community to participate, learn, and grow in their Jewish life.

Policy Statement:

We expect that participants in any education or camp programs that require registration at Congregation B’nai Israel, (including staff) have age-appropriate vaccines recommended by the American Academy of Pediatrics (AAP) and the Centers for Disease Control (CDC).  To discuss this Immunization Policy further, please make an appointment with the Director of Education.

Policy Exceptions:

We recognize that individuals who have had a documented allergy or severe adverse reaction to a particular vaccine will not be able to receive further doses of that individual vaccine. In addition, individuals with medical conditions such as congenital immunodeficiency or HIV, persons receiving chemotherapy, transplant patients, and persons receiving immunosuppressive drugs and chronic steroids, will not be able to receive certain vaccines. In these instances, we understand that the person may not be fully immunized. We do expect, however, that they will be up to date on all vaccinations that they are able to have and that they inform the Director of Education of their immunization status.

If your child is not fully vaccinated for any reason, we reserve the right to ask you to keep your child out of Congregation B’nai Israel programs. This way we can best reduce possible exposure for your child and the community as a whole.

Optional Donation:

Tue, July 23 2024 17 Tammuz 5784