Test Subscription Payments Religious School Registration 2016-2017/5777 1Introduction from Rabbi Allison Berlinger, Director of Education2Student Information3Medical Consents and Emergency Contact Info4Family Information5Additional Items and Checkout Welcome! Registration for 2016-2017/5777 is now live! Each family need only complete ONE online form to register students for the upcoming school year. Payment can be made online with a credit card and will be in the last steps of the registration form. Payment can be made in full or a choice of two installment plans. Please note that you will be charged a one-time $10.00 administrative fee for choosing one of the payment plans. Payment in full will not incur the additional fee. Registration will be complete upon receipt of payment OR when updated payment arrangements have been made. The tuition rates below are pending final approval at our congregation's annual meeting on June 14, 2016: Sunday Funday (Pre-K, once a month) $180 non-members or members Kindergarten (Sundays only) $565 non-members or members 1st - 2nd Grade (Sundays only) $1355 non-members/$840 members 3rd Grade (Sundays only) $840 4th - 6th Grades (2x per week) $1560 4th - 5th Grades (Sunday, plus Skype Hebrew instruction) $2000 7th Grade (Monday evenings and Wednesday afternoons) $1670 8th Grade (Monday evenings) included in BBM Fee 9th - 10th Grade (Monday evenings) $960 11th - 12th Grade (Monday evenings) $595 Youth Group (9th-12th Grades) $36 Families that enroll 3 or more children in grades K through 12 will receive a 3% discount on total tuition. Sunday Funday, Kindergarten, 1st and 2nd grades are open to all regardless of temple membership; 3rd through 12th grades require current membership at Temple Beth Abraham in order to enroll a child in our Religious School. At Temple Beth Abraham we are committed to providing a quality Jewish education for all of our students regardless of our family’s financial means. Scholarships are offered on the basis of financial need. The process of applying for and receiving tuition assistance is always kept strictly confidential. We welcome and greatly appreciate contributions to the Pincus Fund which helps TBA to offer scholarships to those in need. In the past, these additional payments have helped the school support many scholarships. In addition to tuition payment, families must be current on their pledge to Temple Beth Abraham. If you have any questions about your account, please contact Stuart Skolnick directly at 914.631.1770 x13. Please note that payment plans and special financial arrangements are NEW each year. A few items to highlight: All payments for tuition must be made via credit card. The Skype option is available for 4th and 5th graders only. Space is limited and will be on a first-come/first-served basis. Please note that at this time, 4th grade Skype is fully enrolled and we are starting the waiting list. PLEASE CALL THE OFFICE IF YOU WOULD LIKE TO BE ON THE WAITLIST. In the meantime, please enroll your child in the traditional 4th grade option. Submitting this registration requesting the Skype option is not a guarantee that space will be available. We will be in touch as soon as we know. Tuition is non-refundable after October 1, 2016. Prior to this date, cancellations can be accepted minus a $150 non-refundable deposit. As has been the case in the past, a family's registration for the new school year is not complete until all financial obligations to the Temple for the current year have been met and a zero balance on your statement has been achieved. Registration materials will not be processed until all prior obligations have been met. Therefore, if you have an outstanding balance, we strongly urge you to resolve it as soon as possible. A welcome back letter with the name of your child's teacher will be sent to you at the end of August. The class lists will be available on the first day of classes in September. If you need any assistance, please let us know and we'll be happy to help! As always, thank you for your support as we plan for the upcoming year. Our goal is to provide your children and your family with the best Jewish education possible. Wishing you a fantastic and sun-filled summer! Looking forward to a wonderful year of learning, community and chesed. L'shalom, Rabbi Allison Berlinger Director of Education Student 1 InformationStudent 1 Name* First Last Student 1 Date of Birth* MM slash DD slash YYYY Student 1 Hebrew Name Name of Student 1's School* Student 1 Grade Fall 2016* Student 1 Gender*Male/Female?MaleFemaleStudent 1 Email (optional) Student 1 Grade & Class at TBA*Sunday Funday and Kindergarten-2nd Grades are open to all. In order to enroll your child in 3rd-12th Grades, you must be a current member of Temple Beth Abraham. Please note that dinner is included for all 7th-12th Graders on Mondays evenings. Please select a Grade and class option below:Please select grade and class optionSunday Funday (Pre-K with parent); one Sunday per month - $180Kindergarten-Non-Member; Sundays 9-11am - $565Kindergarten-Member; Sundays 9-11am - $565First Grade-Non Member; Sundays 9-11am - $1355First Grade-Member; Sundays 9-11am - $840Second Grade-Non Member; Sundays 9-11am - $1355Second Grade-Member; Sundays 9-11am - $840Third Grade; Sundays 9-11am - $840Fourth Grade; Sundays 9-11am & Mondays 4:30-6:30pm - $1560Fifth Grade; Sunday 9-11 am & Monday 4:30-6:30pm - $1560Fifth Grade Skype; Sunday 9-11am & Mid-week Hebrew Tutoring - $2000Sixth Grade; Sundays 9-11am & Wednesdays 4:30-6:30pm - $1560Seventh Grade; Mondays 6:15-8:15pm (incl. dinner) & Wednesdays 4:30-6:30pm - $1670Eighth Grade; Included inBar/Bat Mitzvah Fee; Mondays 6:15-8:15pm (incl. dinner), $0Ninth Grade; Mondays 6:15-8:15pm (incl. dinner)- $960Tenth Grade Confirmation; Mondays 6:15-8:15pm (incl. dinner) - $960Eleventh Grade; Mondays 6:15-8:15pm (incl. dinner) - $595Twelfth Grade; Mondays 6:15-8:15pm (incl. dinner) - $595Please note that space in the Skype option is limited and will filled be on a first-come/first-served basis. Submitting this registration requesting the Skype option is not a guarantee that space will be available. At this time, 4th grade Skype is fully enrolled; if you would like to be on the wait list, please contact the office.Student 1 Medications*Please list any medications that your child takes (or "none" if not applicable).Student 1 Allergies*Please indicate any food or medication allergies (or "none" if not applicable).Does student 1 have an IEP or 504 Plan in school?*IEP or 504 Plan?NoYesWe will contact you to discuss any accommodations that your child might need.Do you have a 2nd child to register?NoYesStudent 2 InformationStudent 2 Name* First Last Student 2 Date of Birth* MM slash DD slash YYYY Student 2 Hebrew Name Name of Student 2's School* Student 2 Grade Fall 2016* Student 2 Gender*Male/Female?MaleFemaleStudent 2 Email (optional) Student 2 Grade & Class at TBA*Sunday Funday and Kindergarten-2nd Grades are open to all. In order to enroll your child in 3rd-12th Grades, you must be a current member of Temple Beth Abraham. Please note that dinner is included for all 7th-12th Graders on Mondays evenings. Please select a Grade and Class Option below:Please select grade and class optionSunday Funday (Pre-K with parent); one Sunday per month - $180Kindergarten-Non-Member; Sundays 9-11am - $565Kindergarten-Member; Sundays 9-11am - $565First Grade-Non Member; Sundays 9-11am - $1355First Grade-Member; Sundays 9-11am - $840Second Grade-Non Member; Sundays 9-11am - $1355Second Grade-Member; Sundays 9-11am - $840Third Grade; Sundays 9-11am - $840Fourth Grade; Sundays 9-11am & Mondays 4:30-6:30pm - $1560Fifth Grade; Sunday 9-11 am & Monday 4:30-6:30pm - $1560Fifth Grade Skype; Sunday 9-11am & Mid-week Hebrew Tutoring - $2000Sixth Grade; Sundays 9-11am & Wednesdays 4:30-6:30pm - $1560Seventh Grade; Mondays 6:15-8:15pm (incl. dinner) & Wednesdays 4:30-6:30pm - $1670Eighth Grade-Included in Bar/Bat Mitzvah Fee; Mondays 6:15-8:15pm (incl. dinner), $0Ninth Grade; Mondays 6:15-8:15pm (incl. dinner)- $960Tenth Grade Confirmation; Mondays 6:15-8:15pm (incl. dinner) - $960Eleventh Grade; Mondays 6:15-8:15pm (incl. dinner) - $595Twelfth Grade; Mondays 6:15-8:15pm (incl. dinner) - $595Please note that space in the Skype option is limited and will filled be on a first-come/first-served basis. Submitting this registration requesting the Skype option is not a guarantee that space will be available. At this time, 4th grade Skype is fully enrolled; if you would like to be on the wait list, please contact the office.Student 2 Medications*Please list any medications that your child takes (or "none" if not applicable).Student 2 Allergies*Please indicate any food or medication allergies (or "none" if not applicable).Does student 2 have an IEP or 504 Plan in school?*IEP or 504 Plan?NoYesWe will contact you to discuss any accommodations that your child might need.Do you have a 3rd child to register?NoYesStudent 3 InformationStudent 3 Name* First Last Student 3 Date of Birth* MM slash DD slash YYYY Student 3 Hebrew Name Name of Student 3's School* Student 3 Grade Fall 2016* Student 3 Gender*Male/Female?MaleFemaleStudent 3 Email (optional) Student 3 Grade & Class at TBA*Sunday Funday and Kindergarten-2nd Grades are open to all. In order to enroll your child in 3rd-12th Grades, you must be a current member of Temple Beth Abraham. Please note that dinner is included for all 7th-12th Graders on Mondays evenings. Please select a Grade and Class Option below:Please select grade and class optionSunday Funday (Pre-K with parent); one Sunday per month - $180Kindergarten-Non-Member; Sundays 9-11am - $565Kindergarten-Member; Sundays 9-11am - $565First Grade-Non Member; Sundays 9-11am - $1355First Grade-Member; Sundays 9-11am - $840Second Grade-Non Member; Sundays 9-11am - $1355Second Grade-Member; Sundays 9-11am - $840Third Grade; Sundays 9-11am - $840Fourth Grade; Sundays 9-11am & Mondays 4:30-6:30pm - $1560Fifth Grade; Sunday 9-11 am & Monday 4:30-6:30pm - $1560Fifth Grade Skype; Sunday 9-11am & Mid-week Hebrew Tutoring - $2000Sixth Grade; Sundays 9-11am & Wednesdays 4:30-6:30pm - $1560Seventh Grade; Mondays 6:15-8:15pm (incl. dinner) & Wednesdays 4:30-6:30pm - $1670Eighth Grade-Included in Bar/Bat Mitzvah Fee; Mondays 6:15-8:15pm (incl. dinner), $0Ninth Grade; Mondays 6:15-8:15pm (incl. dinner)- $960Tenth Grade Confirmation; Mondays 6:15-8:15pm (incl. dinner) - $960Eleventh Grade; Mondays 6:15-8:15pm (incl. dinner) - $595Twelfth Grade; Mondays 6:15-8:15pm (incl. dinner) - $595Please note that space in the Skype option is limited and will filled be on a first-come/first-served basis. Submitting this registration requesting the Skype option is not a guarantee that space will be available. At this time, 4th grade Skype is fully enrolled; if you would like to be on the wait list, please contact the office.Student 3 Medications*Please list any medications that your child takes (or "none" if not applicable).Student 3 Allergies*Please indicate any food or medication allergies (or "none" if not applicable).Does student 3 have an IEP or a 504 Plan?*IEP or 504 Plan?NoYesWe will contact you to discuss any accommodations that your child might need.Do you have a 4th child to register?NoYesPlease submit your registration form with the information for your first 3 children and contact the office to provide the information regarding any additional children you wish to register with the school. Medical ConsentsMedical Consent* This information and health history is correct and complete to my knowledge. The person/s herein described has permission to engage in all program activities except as noted. I hereby give permission to the Temple Beth Abraham Religious School Staff and its authorized representatives to seek emergency medical treatment including ordering x-rays or routine tests. I agree to the release of any records necessary for insurance purposes. I give permission to the Temple Beth Abraham Religious School Staff and its authorized representatives to arrange necessary related transportation for my child. In the event that I cannot be reached in an emergency, I hereby give permission to the physician/health care provider selected by Temple Beth Abraham to secure and administer treatment, including hospitalization, for the person/s named above. Medical Expense Consent* It is understood that a conscientious effort will be made to locate me or my spouse before any action will be taken. If it is not possible to locate us, we will accept this expense. Emergency Contact InformationFamily Physician Name* Physician's Phone*Emergency Contact Name* Emergency Contact Phone*Emergency Contact's Relationship to Student* Additional Information About StudentsIf there is additional information you feel we should know about your child(ren), please include it here: Family InformationMembership Status at Temple Beth Abraham*Families may enroll their children in one year of religious school (K-2) prior to becoming Temple members. Pre-K Sunday Funday does not count towards this one year. Please inquire about our Gateway Membership program for discounted combined membership at both Temple Beth Abraham and JCC on the Hudson, and about our Flexible Voluntary Contributions program for membership at TBA.Membership Status?Current TBA MemberBecoming a TBA MemberBecoming a Gateway Member (oldest child in K-2)Non-member (oldest child in K-2 and has not been a Gateway member in the past)Parent Name (1)* First Last Parent Name (2) First Last Primary Family & Student Address*This address will be used for all Religious School postal mailings Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Telephone*Email*(A confirmation will be emailed to this address and be used for all Religious School communication.) Enter Email Confirm Email Parent 2 Mailing Address (if different than above) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Cell Phone (Parent 1)*Cell Phone (Parent 2)Student(s) reside(s) with:*Both parentsMotherFatherDo you have any younger children that you are not registering with the school at this time?Please provide us with their names and dates of birth so TBA can be prepared for your future Religious School needs and so that we may provide you information about other programs that may be suitable for themNoYesNames and Dates of Birth of Younger ChildrenDirectory Consent I hereby give my permission for Temple Beth Abraham Religious School to print our address and phone number on the class roster, which will be distributed to my child’s class and in the Temple Beth Abraham Religious School Directory which will be distributed to congregation families and Temple Beth Abraham Youth Programs participants. Photo/Video Release I hereby give my permission to Temple Beth Abraham Religious School to take photographs and/or video of my child(ren) to be utilized for Temple Beth Abraham publications, newsletters, and special projects. I understand that pictures will not be utilized outside of the Temple Beth Abraham community without my prior consent. Sunday School AidesPlease indicate below if your child (7th grade and up) is interested in being an aide on Sunday mornings.List student's name(s) below:Please note that volunteering as an aide does not fulfill the Bar/Bat Mitzvah requirement for a Mitzvah Project. Preference is given to past aides in our program. Available slots are filled giving priority to our oldest students first.Tuition/Deposit DueTotal TuitionTotal deposit/registration fees due. $150 of the deposit is nonrefundable. No refunds will be issued after October 1, 2016.Large Family DiscountFamilies with three or more children enrolled in grades K through 12 will receive a 3% discount on total tuition. Price: $0.00 Additional ItemsYouth Group Quantity9th – 12th Grade. Some activities may require additional payment. Please use the 'quantity' field to indicate the number of children enrolling in the Senior Youth Group Price: $36.00 Quantity Pincus FundPlease consider giving the gift of a Jewish education to another child in the community by making a tax deductible donation to the Pincus Fund. The Pincus Fund is a restricted fund of Temple Beth Abraham used to provide scholarships for children to attend Religious School. $360 $180 $72 $36 No thank you. Or I am donating a different amount below Pincus - Other amount QuantityTo donate an amount other than one listed above to the Pincus Fund, please enter the $ as "quantity" below: Price: $1.00 Quantity Total Amount DueTotal Amount Price: $0.00 How do you wish to pay?*You may choose to pay in full or one of two installment plans. Please note: choosing either of the installment plans will incur a $10 administrative fee. Payment installment options are: * Two payments: half to be made now at completion of form, and a second payment in 90 days; * Four payments: 1/4 to made now at completion of form, and three additional monthly payments.Select Payment MethodPayment in Full by Credit Card via PayPalTwo Installments by Credit Card via PayPal (2nd Payment in 90 days)Four Installments by Credit Card via PayPal (Monthly Payments)The above amount presents a financial burden. I will contact the office to apply for a Pincus Fund Scholarship within 15 days of completing this form.All credit card payments are processed through TBA's PayPal account. You do not need a PayPal account to make a credit card payment on the PayPal site.Please contact the office within 15 days to discuss applying for a scholarship and setting up a payment plan. Scholarship awards are made available by the Pincus Fund.Installment Plan Administrative Fee Price: $10.00 Amount Per Payment (Two Installments) Price: $0.00 Amount Per Payment (Four Installments) Price: $0.00