Registration for Toddler – 7th Grade Home > Jewish Journeys > Youth Education and Programs > Religious School (Toddler-7th Grade) > Registration for Toddler – 7th Grade Name Please read important information under Tuition & Enrollment before registering. Registration is $50 per child, which will be deducted from your tuition. Registration will not be processed or early discounts awarded if there are outstanding financial obligations associated with religious school, B'Nai Mitzvah, or youth programs. Scroll down to complete the registration form. Use the tab key or mouse to move between fields. When finished, click on SUBMIT at the bottom of page 2. You will be directed to a Registration Payment page to pay by credit card via a safe, secure PayPal page. You will receive an email confirmation that your registration has been processed. Child #1 Information First Name * Name child Prefers to be Called * Last Name * Gender Identification * e.g. Female Preferred Pronoun * e.g. she Date of Birth * e.g. 12/1/1990 Age * Infant - 18 months 19 months through 2 years 3 years 4 years 5 years 6 years 7 years 8 years 9 years 10 years 11 years 12 years 13 years Age 14 or older Enroll In * Pre-K (2-3-4 year old) K-6th 7th and Heart of B'Nai Mitzvah Club 5-6 Club 5-6 Youth Group for grades 5 & 6. Meets monthly. No charge 2018-2019 Secular School Grade as of September 1 Does your child have special medical or learning needs? Food allergies? We want your child to be safe and have the best learning experience possible. Knowing his/her special needs will help us make that happen. Medical Issues or Needs? * Yes No Learning Needs / Conditions? * Yes No Food Restrictions or Life Threatening Allergies? * Yes No Media Consent and Release Throughout the school year, students may be highlighted in efforts to promote CBHT Religious School activities and achievements. For example, students may be featured in materials to train teachers and/or increase public awareness of our school through newspapers, radio, TV, the web, DVDs, displays, brochures and other types of media, including social media. As the parent or guardian, I hereby give CBHT and its employees, representatives, and authorized media organizations permission to print, photograph, and record my child for use in audio, video, film, or any other electronic, digital and printed media. This is with the understanding that neither CBHT nor its representations will reproduce said photograph, interview, or likeness for any commercial value or receive monetary gain for use of any reproduction/broadcast of said photograph or likeness. I am also fully aware that I will not receive monetary compensation for my child’s participation. I further release and relieve CBHT, its Board of Trustees, employees and other representatives from any liabilities, known or unknown, arising out of the use of this material. Child 1 Media Certify * I certify that I have read the Media Consent and Release liability statement and fully understand its terms and conditions. Child 1 Media Consent and Release * I Grant permission INCLUDING the use of my childs name I Grant permission but NOT INCLUDING the use of my childs name I DO NOT grant permission Emergency Medical Release I hereby give my consent for Congregation Beth HaTephila staff to make available to my child professional emergency medical care if such care is indicated. It is my understanding that a conscientious effort will be made to contact me before such action is taken. It is further understood that in the event that this is not possible, I give my permission for my child to receive proper medical care by any doctor, nurse, paramedic or member of a medical staff of a hospital licensed in the State of North Carolina. Medical Release * I Give my consent I DO NOT give my consent Register a Second Child? * Yes No Total Registration Total: $ If the page doesn't proceed to the next page, it is likely a required field is missing. Scroll up and check all fields with a red *.Parent/Guardian #1 Information First Name * Last Name * Email * Upon submisstion, a copy of the Registration data is sent to this email address. Street Addres Line 1 * Address Line 2 City * State * - Select Province/State - Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Nova Scotia Northwest Territories Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon ==================== Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip * Cell Phone * Enter all 0s if no cell phone Home Phone * Enter all 0's if no home phone If there is a vacancy on the CBHT Religious School Committee, I would like to be contacted about serving? Committee Vacancy 1 Yes No We depend on our parent volunteers to help our school run smoothly. Would you like to volunteer for any of the following? Volunteer Hannukkah Celebration Tu B'shevat Seder Purim Passover Seder Classroom Parent Parent/Guardian #2 Information First Name Last name Mailing Address Email Cell Phone Home Phone or enter all 0's If there is a vacancy on the CBHT Religious School Committee, I would like to be contacted about serving? Commiittee Vacancy 2 Yes No We depend on our parent volunteers to help our school run smoothly. Would you like to volunteer for any of the following? Volunteer Hannukkah Celebration Tu B'shevat Seder Purim Passover Seder Classroom Parent Emergency Contact Information Other than Parent or Guardian listed above First Name * Last Name * Best Phone * Enter all 0s if no phone Alternate Phone Form data is reset upon submission. A copy of the data is sent to Parent/Guardian #1's email.If the page doesn't submit, it is likely a required field is missing or you have entered an invalid email address. Scroll up and check all fields with a red *.