Religious School & Youth Group Member Registration 2021-2022 - Form

PLEASE LOG IN TO YOUR ACCOUNT BEFORE YOU BEGIN
GUARDIAN INFORMATION

GUARDIAN #1

* Guardian #1 First Name

Guardian #1 Last Name

* Local Address

City

State

Zip

Guardian #1 Email

Guardian #1 Cell Phone

* I (Guardian #1) give permission to receive messages and alerts via text to this designated cell phone.

YesNo

Is there a second guardian?

No, there is no second guardianYes, I would like to add a second guardian

GUARDIAN #2

Guardian #2 First Name

Guardian #2 Last Name

Guardian #2 Cell Phone

I (Guardian #2) give permission to receive messages and alerts via text to this designated cell phone.

YesNo

Does Guardian #2 have a different address?

No, same addressYes, I need to enter an additional address.

Street Address

City

State

Zip

STUDENT INFORMATION

STUDENT #1

* Student's First Name

Nickname

* Student's Last Name

* Student's Hebrew Name

Student's Preferred Prounouns

Student's Date of Birth

Student's Cell Phone Number (If Available)

* I, student, give permission to receive messages and alerts via text to this designated cell phone.

YesNo

Grade as of 8/15/2021

School Attending

* Is the student fully vaccinated?

Please Select OneYesNoPlease email copy of most recent vaccination form to office@shaareikodesh.org

* Has the student received the COVID Vaccine?

Please Select OneYesNoPrefer Not to Answer

Please share with us any other important information that will help us provide a safe and caring learning/social environment for your child.

Does your child have any ALLERGIES? (PLEASE LIST ALL ALLERGIES)

Permission to photograph/video your child and use (without names) for promotional purposes?

YesNo

RELIGIOUS SCHOOL OPTIONS

K - 2nd Grade: Judaics Only Sundays 9AM - 12PM In-Person $510 + $50 Safety & Security Annual Fee

Students enrolling in Religious School should select one class option from each section (Judaica and Hebrew)

Judaic Learning Options ($1020 + $100 Safety & Security Annual Fee)

Sundays 9AM - 12PM And Tuesdays 4:30 - 6PM In-PersonSundays 9AM - 12PM In-Person And Tuesdays 4:30PM - 6PM On Zoom

Hebrew Learning Options

Hebrew in a GROUP Setting IN-PERSON (Times TBD)Hebrew in a GROUP Setting on ZOOM (Times TBD)Hebrew in a *PRIVATE Setting IN-PERSON (Times TBD) *Additional fee may apply for Private sessionsHebrew in a *PRIVATE Setting on ZOOM (Times TBD) *Additional fee may apply for Private sessions

Jewish Leadership Class (Post B'nai Mitzvah) – $350

Jewish Leadership Class (Post B'nai Mitzvah) – $350Meets once a month on Zoom (TBD) and one Saturday per month for Lunch & Learn with Rabbi Baum

Madrikhim (Teaching Assistant) Program

Madrikhim (Teaching Assistant) ProgramStudents will receive one community service hour for every hour worked. If you choose this program, you must also register for the above class.

YOUTH GROUP OPTIONS
Youth group empowers Jewish youth to develop friendships, leadership skills, a sense of belonging to the Jewish People, a deep engagement with and love for Israel, and a commitment to inspired Jewish living through meaningful and fun experiences based on the ideology of Conservative Judaism.
Click for more information about Chalutzim (grades 3-5), Kadima (grades 6-8) and USY (grades 9-12)

Chalutzim (3rd-5th Grade) $36

Kadima (6th-8th Grade) $120

USY (9th-12th Grade) $135

Would you like to register a second student?

No, I'm finishedYes I want to register a second student

STUDENT #2

Student #2 First Name

Student #2 Nickname

Student #2 Last Name

Student #2 Hebrew Name

Student #2 Preferred Pronouns

Student #2 Date of Birth

Student's Cell Phone Number (If Available)

* I, student, give permission to receive messages and alerts via text to this designated cell phone.

YesNo

Grade as of 8/15/2021

Student #2 School Attending

* Is the student fully vaccinated?

Please Select OneYesNoPlease email copy of most recent vaccination form to office@shaareikodesh.org

* Has the student received the COVID Vaccine?

Please Select OneYesNoPrefer Not to Answer

Please share with us any other important information that will help us provide a safe and caring learning/social environment for your child.

Does your child have any ALLERGIES? (PLEASE LIST ALL ALLERGIES)

Permission to photograph/video your child and use (without names) for promotional purposes?

YesNo

RELIGIOUS SCHOOL OPTIONS

K - 2nd Grade: Judaics Only Sundays 9AM - 12PM In-Person $485 + $50 Safety & Security Annual Fee with sibling discount.

Students enrolling in Religious School should select one class option from each section (Judaica and Hebrew)

Judaic Learning Options ($995 + $100 Safety & Security Annual Fee with sibling discount)

Sundays 9AM - 12PM And Tuesdays 4:30 - 6PM In-PersonSundays 9AM - 12PM In-Person And Tuesdays 4:30PM - 6PM On Zoom

Hebrew Learning Options

Jewish Leadership Class Post B'nai Mitzvah) – $325 with sibling discount.

Jewish Leadership Class Post B'nai Mitzvah) – $325 with sibling discount.Meets once a month on Zoom (TBD) and one Saturday per month for Lunch & Learn with Rabbi Baum

Madrikhim (Teaching Assistant) Program

Madrikhim (Teaching Assistant) ProgramStudents will receive one community service hour for every hour worked. If you choose this program, you must also register for the above class.

Click for more information about Chalutzim (grades 3-5), Kadima (grades 6-8) and USY (grades 9-12)

Chalutzim (3rd-5th Grade) $36

Kadima (6th-8th Grade) $120

USY (9th-12th Grade) $135

Would you like to register a third student?

No, I'm finishedYes I want to register a second student

STUDENT #3

Student #3 First Name

Student #3 Nick Name

Student #3 Last Name

Student #3 Hebrew Name

Student #3 Preferred Pronouns

Student #3 Date of Birth

Student's Cell Phone Number (If Available)

* I, student, give permission to receive messages and alerts via text to this designated cell phone.

YesNo

Grade as of 8/15/2021

Student #2 School Attending

* Is Student #3 fully vaccinated?

Please Select OneYesNoPlease email copy of most recent vaccination form to office@shaareikodesh.org

* Has the student received the COVID Vaccine?

Please Select OneYesNoPrefer Not to Answer

Please share with us any other important information that will help us provide a safe and caring learning/social environment for your child.

Does your child have any ALLERGIES? (PLEASE LIST ALL ALLERGIES)

Permission to photograph/video your child and use (without names) for promotional purposes?

YesNo

RELIGIOUS SCHOOL OPTIONS

K - 2nd Grade: Judaics Only Sundays 9AM - 12PM In-Person $485 + $50 Safety & Security Annual Fee with sibling discount.

Students enrolling in Religious School should select one class option from each section (Judaica and Hebrew)

Judaic Learning Options ($995 + $100 Safety & Security Annual Fee with sibling discount)

Sundays 9AM - 12PM And Tuesdays 4:30 - 6PM In-PersonSundays 9AM - 12PM In-Person And Tuesdays 4:30PM - 6PM On Zoom

Hebrew Learning Options

Jewish Leadership Class (Post B'nai Mitzvah) – $325 with sibling discount

Jewish Leadership Class (Post B'nai Mitzvah) – $325 with sibling discountMeets once a month on Zoom (TBD) and one Saturday per month for Lunch & Learn with Rabbi Baum

Madrikhim (Teaching Assistant) Program

Madrikhim (Teaching Assistant) ProgramStudents will receive one community service hour for every hour worked. If you choose this program, you must also register for the above class.

Click for more information about Chalutzim (grades 3-5), Kadima (grades 6-8) and USY (grades 9-12)

Chalutzim (3rd-5th Grade) $36

Kadima (6th-8th Grade) $120

USY (9th-12th Grade) $135

EMERGENCY CONTACT & PICK-UP INFORMATION

In addition to guardians, please list an emergency contact/authorized individual for pick up:

Name:

Phone Number:

Relationship:

Can Pick Up? Y/N

Tuition Total

APPLICATION FOR ENROLLMENT AND LIABILITY RELEASE

I hereby submit registration for my child, as listed above, for the Congregation Shaarei Kodesh (CSK) Religious School Program during the 2021-2022 school year. I understand that session and class placement of my child is left to the discretion of the Director. In the event of an emergency, I give permission for my child to be brought to the nearest medical facility and authorize the representative of Congregation Shaarei Kodesh to select a physician, nurse, paramedic or emergency medical technician licensed by the State of Florida, and/or authorize medical treatment, including hospitalization, anesthesia, injection, surgery or other measures which he/she feels are in the best interest of my child. This form also serves as a release form for any trip on which my child participates during the school year. I also, hereby release and agree to defend, indemnify and hold Congregation Shaarei Kodesh (and its officers, directors, agents, volunteers and employees) harmless from any and all damages, injuries, claims and causes of action arising (directly or indirectly) out of my or my child’s participation on any school-sponsored activity or trip. My child has my permission to participate in all activities of the Education Program for which he/she is registered.

By signing this application, the undersigned agrees to pay the total amount of tuition and fees for the 2021-2022 school year. Refunds due to withdrawal are not available. In the event of payment default, CSK reserves the right to cancel the student’s enrollment in school and/or youth groups and the undersigned agrees to pay the expenses of enforcement and collection, including attorney’s fees and costs.

* I have read and understand the above paragraph and I am submitting my registration.

I have read and understand the above paragraph and I am submitting my registration.