PAYQUIQ ONLINE :: The Faster Smarter Way to Pay

Chavaya Registration Grades 7th-12th 2020-2021

Chavaya is Temple Israel of New Rochelle's Religious School program for Kindergarten - 12th Graders.

Applications must be completed in one computer session using a desktop computer or laptop. This application is not "user friendly" with PDA devices.

Complete one application per child. Full payment or first installment of a payment plan is required in order to complete registration. Registrations must be submitted on or before Friday, September 4th.

Contact the Chavaya Office at chavaya@tinr.org with questions.

Information About Child

* Name of Child (Last, First)

* New or Returning?

New Participant
Returning Participant

Nickname

* Birthdate (MM/DD/YYYY)

* Gender

Male
Female

* Primary Address of Child (Address, City, State, Zip)

* Home Phone Number (###-###-####)

* Teen's Cell Phone for Programming Purposes ###-###-####)

* Teen's Email Address

* Teen's Secular Grade as of September 2020

Chavaya Tuition is subsidized by Temple Israel. Please consider paying the actual cost of tuition for the Temple. The difference is a tax deductible donation.

A 3% administrative fee will be added if you choose to pay by credit card.

In registering my teen in the Chavaya program, I am making the financial commitment for the year. I understand that tuition is non-refundable after Tuesday, October 27th.

Please click that you understand that tuition is non-refundable after Tuesday, October 27th.

Registration Options-You must select ONE of the four following options below. Note: As of August 1, we have reviewed the New York State guidelines for serving food. Based on current guidelines we do not feel that our teens would be able to socialize in a manner that they would enjoy under the restrictions. We will continue to monitor guidelines in hopes of being able to serve dinner in late fall, early winter and have included the cost of dinners in the fees listed below. We will be scheduling "Zoom dinners" for each grade for the first two months in order to provide teens with a social outlet.

1. I would like to pay in full at this time, the Actual Cost of Chavaya to Temple Israel.

2. I would like to pay in full at this time, I would like to pay the Chavaya Tuition to Temple Israel.

3. I elect to allow Temple Israel of New Rochelle to deduct the following Actual Cost amount on a monthly basis. I understand that this amount will be deducted over a 9 month period.

4. I elect to allow Temple Israel of New Rochelle to deduct the following Chavaya Tuition amount on a monthly basis. I understand that this amount will be deducted over a 9 month period.

Tikkun Teens

Tikkun Teens: a community service club with monthly events open to 8th-12th graders.Click to register. NOTE: teens registered for the Tuesday evening program or Social Justice 10th grade Confirmation track are automatically enrolled in Tikkun Teens.

$180.00

* includes B'nei Mitzvah preparation **10th and 12th grades are special years in Chavaya. In 10th grade there is typically a class trip to Washington DC and Confirmation Services in the Spring but due to the pandemic, there will be no trip this year. In lieu of the trip all 10th graders will participate in the online Social Justice Academy, organized by the Religious Action Center (RAC). In 12th grade there is a Graduation Shabbat Service. Costs for these special events will be billed later in the year. Confirmation Celebration: $275.00, Graduation Celebration: $75.00.

Social Justice Academy

Meaningful, fun and actionable Jewish social justice education in a virtual setting, for students in grades 9th-12th. This program will be run by the Religious Action Center, an arm of the Reform Movement which works to educate, inspire, and mobilize Reform Jews to advocate for social justice. Note: All registered 10th graders will automatically be enrolled in the Social Justice Academy, and do not need to complete the information below.

Unit 1:Civic Engagement. Dates: Wednesday, October 14th & Wednesday, October 21st, Time: 7:00pm. Suggested Fee is $40. Input your contribution. $

Unit 2: Racial Equality, Diversity, Inclusion. Dates: Wednesday, November 11th & Wednesday, November 18th, Time: 7:00pm. Suggested Fee is $60. Input your contribution. $

Unit 3: Action & Advocacy. Dates: Wednesday, February 24th; Wednesday, March 3rd & Wednesday, March 10th. Time: 7:00pm. Suggested Fee is $60. Input your contribution. $

Interested in temple Basketball? Please contact the Basketball Commissioner Jeff Berenbaum at jberenbaum@optonline.net.

Parent Information

* Name of Parent/Guardian 1 (Last, First)

* Parent/Guardian 1 Home Phone Number (###-###-####)

* Parent/Guardian 1 Home Address (Address, City, State, Zip)

* Parent/Guardian 1 Cell Phone Number (###-###-####)

Parent/Guardian 1 Work Number (###-###-####)

* Parent/Guardian 1 Email Address

Name of Parent/Guardian 2 (Last, First)

Parent/Guardian 2 Home Address (Address, City, State, Zip)

Parent/Guardian 2 Home Phone Number (###-###-####)

Parent/Guardian 2 Cell Phone Number (###-###-####)

Parent/Guardian 2 Work Number (###-###-####)

Parent/Guardian 2 Email Address

Name of Parent/Guardian 3 (Last, First)

Parent/Guardian 3 Home Address (Address, City, State, Zip)

Parent/Guardian 3 Home Phone Number (###-###-####)

Parent/Guardian 3 Cell Phone Number (###-###-####)

Parent/Guardian 3 Work Phone Number (###-###-####)

Parent/Guardian 3 Email Address

Teen Engagement Committee: We need Parent Volunteers!

The committee works with Temple Israel staff to help provide teenagers with opportunities to remain involved with Temple Israel and Jewish life. This initiative began last year and we are looking to recruit more parents who are invested in teen engagement.

Click here if you are interested in learning more about the Teen Engagement committee.

Emergency Contact Information if we can't reach a Parent or Guardian

* Name of Emergency Contact 1 (Last, First)

* Emergency Contact 1 Home Phone Number (###-###-####)

* Emergency Contact 1 Cell Phone Number (###-###-####)

* Emergency Contact 1 Relationship to Child

Name of Emergency Contact 2 (Last, First)

Emergency Contact 2 Home Phone Number (###-###-####)

Emergency Contact 2 Cell Phone Number (###-###-####)

Emergency Contact 2 Relationship to Child

Medical/Learning Information

Please provide any information, such as medical needs, which may be of help to the Chavaya Director and faculty.

Medications that your child may need to take during Chavaya programming.

Allergies (especially food allergies). Please be specific.

Will your child need to keep an Epi-Pen in the Chavaya office?

* Physician's Name (Last, First)

* Physician's Phone Number (###-###-###)

* Name of Insurance Company

* Insurance Company ID

* Policy #

* Insurance Company Phone Number (###-###-####)

Immunization Record, COVID release form & Community Brit (Behavior Contract)

* All registered teens must submit an up-to-date immunization record on file, and a COVID release form in order to participate in Chavaya programming. Additionally, the Chavaya Community Brit (Behavior Contract) must be signed by parent(s) and child.

I understand that we will need to submit all forms in order for registration to be complete.

Authorizations

The child listed above has my permission to engage in all Temple Israel of New Rochelle (TINR) Chavaya Programming and Youth Group activities except as noted below.

In the event that I cannot be reached in an emergency, I hereby give permission to TINR to seek emergency medical treatment and arrange necessary related transportation for my child. I hereby give permission to the physician/health care provider selected by TINR to secure and administer treatment, including hospitalization, for the person named above.

When a TINR event is not on the temple premises, I give permission for my son/daughter to be driven to and from the event by an authorized mode of transportation. I agree to indemnify and hold harmless TINR, their employees, volunteers, and members from any harm which may come to my son/daughter while in transport to or from the event, or during said event.

* I am aware that pictures of my child may be taken at TINR events and give permission for them to be posted on the TINR website or printed in TINR publications.

Exceptions for Child

* By checking this box I agree to the above authorization and that the responses are as accurate as possible.

Please make sure the registration form is completed in its entirety and click "register."

Donation to Chavaya

We greatly appreciate your contribution to help defray the costs of our program. Donations are tax deductible.

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Total: