2022-23 HSRS Student Registration Form - Form

Shalom Parents!

Welcome to the 2022-23 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 $35/month per child ($315 per child, per year)

* CHS Member?

Add your student(s) to the form by clicking on the 'plus' sign below. Click the plus sign again for each additional child.

* Student Name

Student Hebrew Name (if known)

Student Phone

Student Email

* Birthdate

* Grade for 2022/23 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).

Registration Fee

In order for our teachers to be ready with materials needed on the first day of school, there is a $30 per child fee for students Kindergarten - 7th Grade due at time of registration.

Tuition

All pricing shown below is per child per month and includes tuition, security and materials. Please enter the number of children you are registering in each grade.

Beresheet: In the Beginning

Program Fee: $18/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: $85 per month
Sunday mornings August 21 through May 21

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: $115 per month
Sunday mornings August 21 through May 21
Wednesday evenings through August 24 to May 17

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

4th Grade

5th Grade

6th Grade

7th Grade

Will your child join us for pizza on Wednesday evening?

Teen Program

We are excited to announce a new program for teens this year. This program is open to all teens 8th grade and up!

Program Fee: $30/month
Includes: Lifetime BBYO Membership, two classes per month and all materials.

Number of participating teens in your family

Madrichim Program - Grades 8 - 12

Program fee: Free
Sunday mornings August 21 - May 21.
Teens are no longer paid, but can accumulate volunteer hours for school. After this registration form is submitted, you will receive a separate email that gives more details about the program, the requirements, and your interests.

Enter your preferred grade assignment

Religious School Donations

Did you know that CHS contributes towards the expenses of our program as well? The actual cost of running this program for K-3rd students is $115 per month and $150 per month for 4-7th grade students. Your additional support subsidizes HSRS programs, Teacher Appreciation, and other costs that keep the school running, such as security and cleaning.

Scholarship Fund Donations

Scholarship donations help other families pay for their children's Religious School education when they are in need of financial help. We 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

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.

* Emergency 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