Registration - BnosMelechSeminary

Bnos Melech Student Application

Student Information

Please upload a recent picture of yourself

Full name as it appears on Passport or ID card

Name you prefer to be called by

Date of Birth

Hebrew Date of Birth (day, month, year)

Address (including City, State, Country, Zip code)

Home Telephone

cell phone

Social Security # and / or Teudat Zehut #

Social Security Teudat Zehut

Parents Information:

Father's Name

Occupation

Cell Phone

Mother's Name

Occupation:

Cell Phone:

Parents' marital status

Married Separated Divorced Other

Siblings:

Name / Age / School or Occupation

Education:

Please list all schools and seminaries that you have attended

Name of School / Years attended / Reason for Change

Questionnaire

How did you hear about BMS ?

Why are you interested in joining BMS ?

List any talents, interests, and hobbies that you have

Tell us more about yourself

Medical Information:

Please list any medical conditions or allergies that you have. (If none, please write none). All information will remain confidential among the staff.

Please list any medications / dosages, and or supplements you are currently taking. Please include the Doctor (and contact information) who prescribed or recommended them. (if none, please write none).

Consent Form to be filled out by parents (if student is less than 18 years old) or by student (if 18 years old or above). If Student will be turning 18 during the year both Parent and Student should consent.

Authorization for the release of information:

For the welfare of our daughter (or for my own welfare) I, (the above listed Parent or Student), hereby authorize the BMS Administration/ Clinical staff to exchange information regarding (our daughter or myself) with any medical professional / therapist etc. who is treating or caring for (her, or me) during (her, or my) stay at BMS.

I the above listed parent agree to the authorization I the above listed student agree to the authorization Both Parent and Student agree to the authorization (if Student will turn 18 during the school year please select this option).

Recommendations:

Please supply 2 names of recommendation and their contact details. One of them must be either a Principal, School Counselor, or Teacher at your previous school.

Recommendation #1: Name and position at your previous school: Telephone: Cell Phone: Email:

Recommendation #2: Name: Telephone: Cell Phone: Email:

Emergency Contact:

Please provide the contact details of 2 people in Israel who can be contacted in case of an emergency. Please confirm that they have agreed to be listed as your emergency contact.

Emergency Contact #1: Name: Relationship: Cell Phone: Email:

Please confirm that Emergency contact #1 has agreed to be your emergency contact.

Yes, Emergency contact #1 has agreed to be an emergency contact

Emergency Contact #2: Name: Relationship: Cell Phone: Email:

Please confirm that Emergency contact #2 has agreed to be your emergency contact.

Yes, Emergency contact #2 has agreed to be an emergency contact.

Tuition Agreement:

The following section must be signed either by yourself or by the person who is taking responsibility for payment.
If it is you, please type your name and date in the signature line. If it is another person, please enter their name
and ask them to contact us to confirm their acceptance of financial responsibility.
Without this confirmation, registration cannot be processed.

The fee for the 2023-24 academic year is $30,000.
Tuition must be paid, or a payment plan must be in place, before attendance is allowed.

In the event that a student decides to leave or is asked to leave due to noncomplance or any other reason,
tuition responsibility will continue for 30 days from the date the student departs from BMS (with her belongings)

BMS is closed every other Shabbos and for some of the Yomim Tovim.

We do our best to take great care of all our students at all times, however we assume no responsibility whatsoever
over their physical and emotional well-being.

We also do not take responsibility for student's belongings.
All items should be clearly labeled, and anything left unattended becomes Hefker.

Every student is required to have medical insurance during their stay at the seminary. Should medical insurance not be purchased,
all medical expenses (including but not limited to doctor bills, hospitalization, medicines etc.) will be the responsibility of the parents,

I agree to the above and take full responsibility to the above conditions of payment: Name:

Cell PHone

Home Phone:

Address:

Email:

Signature (type) / Date:

Parental Consent to Programming:

Please mark the following:

My daughter may participate in all programming the that seminary offers. My daughter may also join independently planned trips, but only with staff permission. All medical decisons will be made by the staff if the parents are not available at that time. In case a student requires hospitalization, it is the parents' responsibility to have someone accompany and stay with her there if needed.

Student Commitment:

Remaining at BMS is conditional upon your compliance with all of the rules listed below:

Please check off that you have read and accept each rule.

Students will dress in a refined and tzinus way at all times as befitting for a Bas Yisroel.

A basic filter is required on all phones and computers that have internet access.

Phones and computers are for personal use only. No lending out.

Phones are required to be turned in before going to sleep, or by 12:00 am. They will be available for pickup at 7:30 am.

Non Jewish music is not recommended, and is only permitted to be played through headphones or earbuds.

Attendance at all classes, activities, and trips is mandatory. When unable to attend for a valid reason you must receive permission in advance.

All Shabbos / Yom Tov destinations must be pre-approved at least 48 hours in advance.

Every student must take part in cooking, baking, and cleaning duties (Toranut).

Alcohol, cigarettes, vapes, and e-cigs of any type, and other types of damaging substances are forbidden in and out of the dorm.

Curfew is 10:00 PM every night and 11:00 PM on Motzai Shabbos during the summer months. Please keep noise to a minimum after 10:00 PM. Hot water and the main light will be turned off at midnight. Please be in your bedroom by 12:30 AM.

You may not enter other bedrooms at any time.

There will be other rules included in the orientation packet. These are also mandatory for your success at BMS.

The following declaration includes all of the items listed above. I hereby submit my application to Bnos Melech Seminary. I undertake to comply with all rules, regulations and standards at all times. I certify that all the statements made in this application are complete and accurate to the best of my knowledge.Please Sign (type) and Date

Application Form