Bet Sefer Registration 2019-20 - Form - Congregation Shaarei Shamayim

Welcome to our new online Bet Sefer registration form. The first half of tuition is due September 1 and the second half is due January 1. You will have the option to pay in monthly installments. Please note that you are required to be a member and submit your 2019-2020 membership forms in order for your child(ren) to attend Bet Sefer. Please contact Joy Zotalis with any questions at 257-2944 or office@shamayim.org.

FAMILY INFORMATION

* New / Returning Family

* Parent/Guardian 1 First Name

* Parent/Guardian 1 Last Name

Home Phone

* Cell Phone

Work Phone

* Email

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Home Phone (if different)

Cell Phone

Work Phone

* Health Insurance Company

* Policy #

* Name and Phone Number of Student Primary Physician

* Emergency Contact Information

Please provide the name and number of a local friend or family member who can be contacted in case of an emergency (if parent/guardian is unreachable).

STUDENT INFORMATION

* Student #1 First Name

* Student #1 Last Name

* Grade

* Date of Birth

MM/DD/YYYY

Allergies or medical conditions

Please provide any additional information about your child regarding learning, social, emotional, or behavioral issues that will help us offer the best possible school experience:

If no other children skip to the next section

Student #2 First Name

Student #2 Last Name

Grade

Date of Birth

MM/DD/YYYY

Allergies or medical conditions

Please provide any additional information about your child regarding learning, social, emotional, or behavioral issues that will help us offer the best possible school experience:

If no other children skip to the next section

Student #3 First Name

Student #3 Last name

Grade

Date of Birth

MM/DD/YYYY

Allergies and Medical Conditions

Please provide any additional information about your child regarding learning, social, emotional, or behavioral issues that will help us offer the best possible school experience:

Is there anything about your child(ren) you would like to share with Rabbi Laurie (e.g., divorce, custody arrangements, ongoing illness, recent death in the family)?

PARENTAL CONSENT

* Medical Emergency Release: I hereby give my permission to the physician or medical professional selected by staff to secure proper treatment for my child, which I understand might include hospitalization, injections, anesthesia, or surgery. I recognize that I will be responsible for any costs incurred for this treatment.

Please Select OneYesNo (If selected, you will be required to be on premise for all Bet Sefer sessions and programs your child(ren) attends.)

* Transportation Release: I understand that any volunteer driver who transports my child will have certified that s/he has auto insurance which will cover any injuries to Shaarei Shamayim Bet Sefer students who s/he is driving, if there should be an accident; has a valid driver's license which is not currently suspended or revoked; does not have a health condition which will impair his or her ability to drive safely; will use an automobile for driving Shaarei Shamayim Bet Sefer students which is in safe mechanical condition; will promptly notify the Bet Sefer Director if s/he is no longer able to certify any of the above four items. I hereby permit my child to attend all Congregation Shaarei Shamayim Bet Sefer school field trips.

Please Select OneYesNo (If selected, you will be responsible for transporting your child for all field trips and unable to ride share.)

If you are willing to drive students for occasional field trips, please check the below boxes:

I have auto insurance which will cover any injuries to Shaarei Shamayim Bet Sefer students whom I am driving, should there be an accident.I have a valid driver's license which is not currently suspended or revoked.I do not have a health condition which will impair my ability to drive safely.I will use an automobile for driving Shaarei Shamayim Bet Sefer students which is in safe mechanical condition.I will promptly notify the Bet Sefer Director if I am no longer able to certify any of the above four items.

* Is this information correct to the best of your knowledge?

Please Select OneYesNo

Should a place on the Children's Education committee become available, would you be interested in joining?

YesNoMaybe

Would you like to be a class parent? Duties include arranging snack, welcoming new parents to the community, and being a liaison to the teachers.

YesNoMaybe

Would you like to occasionally help plan holiday celebrations or do other discrete tasks?

YesNoMaybe

May we include your contact information in the Bet Sefer roster?

YesNo

PAYMENT INFORMATION

Key to Grades
Aleph: Kindergarten | Bet: 1st grade | Gimmel: 2nd grade | Daled: 3rd grade | Hay: 4th grade | Vav: 5th grade | Zion: 6th grade | Chet: 7th grade

Tuition
Gan, Aleph, Bet, Gimmel: $350 (Sunday only)
Daled, Hay, Vav, Zion: $575 (Sunday and tutoring)
Chet: $350 (Sunday only)
Chet: $575 (Sunday and tutoring)

Families with more than one child can select the multi-child discount of $75 for each additional child up to $150.

For scholarship information please contact Rabbi Laurie. If requesting, select 'bill to account' when registering.

* Enter number of children at each rate

Gan Aleph Bet Gimmel (Sunday only)

Daled Hay Vav Zion (Sunday and tutoring)

Chet (Sunday only)

Chet (Sunday and tutoring)

Multiple Child Discount ($75) - Select "1" for 2 children, or "2" for 3 or more.

Total

Upon hitting "Submit" you will be taken to a payment page where you can enter your credit/banking information to make a payment or select payment by check.