CBS Religious School Registration - Form - Congregation Beth Shalom Napa Valley

Please fill this form out for each child.

(CBS members, please login first)

Religious School Fee Schedule 5778-5779 / 2018-2019

Programs:

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

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

* It is our expectation that students in Grades 4-7 will attend Hebrew School on Wednesdays from
4:00 - 5:30PM. This is a required component of the B'nai Mitzvah program.

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 Stephen Gugenheim at: gugietx@gmail.com to make special arrangements.

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.

* NON-MEMBER - Grade in Fall of 2018

* Day/Secular School:

Student's Email Address:

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

Student's Cell Number:

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

Medical Information

* Physician Name

* Physician Phone Number

* Dentist Name

* Dentist Phone Number

* Medical Insurance Company

* Medical Insurance Policy Number

* 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"

* 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:

* Zip Code:

* Cell Phone:

Home Phone:

* Email Address:

Work Phone:

* Religious Affiliation:

Parent #2

Last Name:

First Name:

Street Address:

City:

Zip Code:

Cell Phone:

Home Phone:

Email Address:

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!

Total Amount Due:

Method of Payment

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

2. Set up automatic payment/s on PayPal* using your credit card on the payment page.

* There is a convenience fee for all Credit Card (PayPal) transactions.

* Payment Method:

Please Select OnePay by Credit Card (PayPal)Bill to my CBS Account (Check or Credit Card accepted)

* If billing to your CBS Member account, You Must Select a Payment Choice:

Full Amount - Due by September 1, 20182 Payments - September 1, 2018 and December 1, 20184 Payments - 9/1/18, 11/1/18, 1/1/19, 3/1/19

Please Sign and click the Submit button below to proceed to the payment page. You will then select either "PayPal" or "Bill to my account."

Signature (please type full name)