2020-21 HSRS Student Registration Form - Form

Shalom Parents!

Welcome to the 2020-21 religious school year for Congregation Har Shalom. We look forward to learning with your children. If you have any questions as you fill out the form, please feel free to contact Nicki Shamis, Religious School Director, at HSRSDirector@congregationharshalom.org.

Please note: At this time, it is not possible to 'save' your form and return to finish it later. It must be completed in a single session.

* Parent First Name

* Parent Last Name

Parent First Name

Parent Last Name

* Parent Email

Additional Email

* Parent Phone

Additional Phone

* Address

Apartment Number

* City

* State

* Zip

Non-Member Students:
Families with children in grades K through 5 may enroll their children in the CHS Religious School as non-members for a maximum of two years. The additional tuition for non-members is $20/month per child ($180 per child, per year)

* CHS Member?

* Number of children registering for religious school

In order for our teachers to be ready with materials needed on the first day of school, there is a $25 fee due at time of registration. If you prefer to pay by check, please send before the first day of school

Click on the 'plus' sign to add your child(ren)'s information.

* Student Name

Student Hebrew Name (if known)

Student Phone

Student Email

* Birthdate

* Grade for 2021/22 school year grade. Preschool, use 'PK'

* Gender

If other, please identify here

Health and Wellness

Please list any known food or environmental allergies, including whether your child requires that an EPI pen be kept onsite. Also, please list any known learning needs we should be aware of (if applicable).

Tuition

All pricing shown below is per child per month and includes tuition and materials. While we are remote learning, materials will be dropped off at your child's home prior to the lesson. Security fees, snack fees, and pizza plans will not be charged during remote learning. Please enter the number of children you are registering in each grade.

For CHS Members who Self-Pay and Non-Members: Statements will be sent by the 15th of the month for the following month. Payment is due the first of the month

For CHS Members who Auto-Pay: Charges for religious school will be included monthly with your membership and security payments on either the 1st or the 15th (whichever you have selected). For those who pay membership and security quarterly, annually or bi-annually, religious school charges will be charged monthly on the 1st of the month unless you request otherwise.

Beresheet: In the Beginning

Program Fee: $10/month

Once a month program for Pre-K kids and their adults; October thru May. *5-year-olds not yet in Kindergarten are welcome to attend.

Number of participating preschoolers in your family

Kindergarten thru 3rd Grade

Program Fee: $73
Sundays: via Zoom

Please enter the number of students attending in each grade in the fields below.

Kindergarten

1st Grade

2nd Grade

3rd Grade

4th thru 7th Grades

Program Fee: $84
Sundays: via Zoom
Wednesdays: via Zoom

Please enter the number of students attending each grade in the fields below.

4th Grade

5th Grade

6th Grade

7th Grade

Teen Program

We are excited to announce our new program for teens, focusing on social justice. This group meets twice a month, following the wonderful Living the Legacy Civil Rights curriculum from the Jewish Women's Archive. This program connects the history and activism of Jews during the Civil Rights movement to our role as Jews in the modern-day fight for racial justice. This program is open to all teens 8th grade and up!

Program Fee: $20/month
Includes: Lifetime BBYO Membership, twice monthly Zoom, and all materials

Please enter the number of teens attending

"Round-Up" Donation Information

Religious School Donations support additional HSRS programs, Teacher Appreciation, and other costs that keep the school running, even during remote learning..
Scholarship Fund Donations help other families pay for their children's Religious School education when they are in need of financial help. We expect an increase in the number of families needing support and thank you in advance for helping other students receive a Jewish Education.

If you would like to make an additional monthly donation amount to either the Religious School or Scholarship Funds, please add the amount in the appropriate box below. All Donations are 100% tax deductible and will be shown as a donation on your year-end tax statement from Har Shalom.

Religious School Monthly Round-Up Donation

Scholarship Monthly Round-Up Donation

We are trying to determine the HSRS community's preference in terms of receiving supplies to support your child's learning. Would you prefer to pick up the supplies during a designated time from Har Shalom's parking lot once a month OR would you prefer the supplies be delivered directly to your doorstep? Please understand that we are gathering preferences only.

Emergency Contact Information

Please provide the name and number of at least one family member or friend that we may contact if we are unable to reach either parent.

* Contact Name

* Contact Phone Number

* Family Physician Name

Physician Phone Number

Is there anyone NOT allowed to pick up your child or children? If so, please list that person's full name below.

Withdrawal Policy

We know life happens, pandemics are unpredictable, and learning looks different than ever before. We have developed a withdrawal policy to keep us all on the same page. Tuition is based on a full school year. In order to maintain our budget and staffing, tuition credits are not given for holidays or personal absences.

If you have a unique attendance circumstance, please contact the School Director, Nicki Shamis. If you need to withdraw your child or teen, notify in writing. A written response is proof that the withdrawal request was received. Absence from the program is not confirmation of withdrawal.

* I have read and understand the Withdrawal Policy

Please selectYes thank you!I have questions and will contact you. Thanks!

Releases

* Photo Release

Please Select OneYes, I agree to the Photo ReleaseNo, I do not agree to the Photo ReleaseI give permission to Har Shalom to photograph my child(ren) during Religious School hours and use for publication purposes, whether electronic, print, digital, or electronic publishing via the internet. This release is needed during in person programming.

* Medical Release

Please Select OneYes, I agree to the Medical ReleaseNo, I do not agree to the Medical ReleaseIf and when the need for medical and/or surgical attention arises during the period of my child(ren)'s official participation in Har Shalom Religious School programs, and listed parents and emergency contacts cannot be contacted, I hereby grant permission for my child(ren) to be treated by qualified authorities at their discretion and that of Har Shalom senior staff. This release is needed for in-person programming.

* Field Trip & Excursion Release

Please Select OneYesNoI authorize my child(ren) to leave Har Shalom for field trips with adequate supervision and advanced notice during the school year. This release is needed for in-person programming.

Total Due Today