Religious School Registration 2021-2022 - Form - Congregation Beth Shalom Napa Valley

Please fill this form out for each child.

(CBS members, please login first)

Religious School Fee Schedule 5782 / 2021-2022

Programs Sundays from 9:30am to 12pm:

Kindergarten - 3rd Grade CBS Member: $530 per child Non-member: $825 per child
4th - 7th Grade * CBS Member: $725 per child Non-member: $1,475 per child

* It is our expectation that students in Grades 4-7 will attend Hebrew School on Sundays. This is a required component of the B'nai Mitzvah program.

Optional Donation: Youth Scholarship Fund to help fund a child's Jewish education (Rec. $50 - $1000)

Financial Aid: No CBS member family is denied a religious education for their children for reasons of financial hardship. If Religious School tuition will place an undue financial burden on your family, please contact Synagogue President Marc Samrick at: marcsamrick@gmail.com to make special payment arrangements BEFORE REGISTERING.

Student Information

* Last Name:

* First Name:

Hebrew Name:

* Gender

Please Select OneFemaleMale

* Birthday:

Select your child's grade from the dropdown below (CBS Members must be logged in).

The Total Amount Due and Payment options will appear at the end of this form.

* Current Members in good standing at CBS for 2021-22 | 5782:

Please Select OneYesNo

* CBS MEMBER - Grade in Fall of 2021

* NON-MEMBER - Grade in Fall of 2021

* Day/Secular School:

Student's Email Address:

If applicable. Parents will be copied on any emails sent directly to students.

Student's Cell Number:

If applicable.

* Allergies:

Please list any allergies your child has. If none, list "N/A"

* Medications:

Please list any medications your child is taking and the frequency. If none, list "N/A"

Emergency Contact Information

Persons other than parents/guardians authorized to pick up child from school. Please list each person's name and primary phone number:

* Contact #1 Name

* Contact #1 Phone Number

* Contact #2 Name

* Contact #2 Phone Number

* What are your goals for your child's Jewish education this year?

* Does your child receive any special services in secular/day school? Does your child have an IEP or 504 plan?

Please explain any accommodations your child receives. If none, list "N/A"

* Have there been any recent changes in home or school life that might affect your child's learning and engagement in Religious School?

Please explain. If none, list "N/A"

Is there anything else you would like us to know about your child?

Parent Information

* You only need to fill out this section for one child:

Parent #1

* Last Name:

* First Name:

* Street Address:

* City:

State:

* Zip Code:

* Cell Phone:

Home Phone:

Work Phone:

* Email Address:

Registration confirmation will be sent to this email.

* Religious Affiliation:

Parent #2

Last Name:

First Name:

Street Address:

City:

Zip Code:

Cell Phone:

Home Phone:

Email Address:

Registration confirmation will be sent to this email.

Work Phone:

Religious Affiliation:

Volunteer

You only need to fill out this section for one child.

The Religious School at CBS needs your help! Jewish holiday celebrations are an important part your child’s learning experience. During class, the students learn the rituals, prayers, and meaning of the holidays. It’s after class that we come together as a community to celebrate with our children. These special events are organized and facilitated by the parents of the Religious School students.

Please pick one event from the list below to help plan and two other events to assist with on the day of the event. Parents new to our school, don’t worry, you will have the support and guidance of the parents of the older students. Veteran parents, we rely on your wisdom and expertise. We couldn’t do it without you!

* You only need to fill out this section for one child:

Please Select OneI have NOT filled out this form for another childI have already filled out this form for another child

Total Amount Due:

Methods of Payment:

1. Bill to your CBS Member Account and pay with Check or Credit card.

2. Set up automatic payment/s using your credit card/e-check on the payment page.

3. Special Payment Arrangement - enter code provided to you from the CBS office in Promo Code via the payment page **

* There is a convenience fee for all Credit Card of 2.5% per transaction.

** Must have previously discussed arrangement with Synagogue President to have received code.

Please Sign and click the Submit button below to proceed to the payment page. You will then select either your preferred payment method and plan before clicking "Confirm & Continue."

Signature (please type full name)