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Chavaya Registration Grades K-7 2019-2020

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 and upload a photo of the child. Full payment or first installment of a payment plan is required in order to complete the application.

Contact the Chavaya Office at (914) 235-1800 x220 with any questions.

Information About Child

* Name of Child (Last, First)

* New or Returning?

New Participant
Returning Participant

Nickname

* Birthdate (MM/DD/YYYY)

* Gender

Male
Female

Child's Hebrew Name

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

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

Child's Cell Phone for Programming Purposes Nitzaneem (3rd & 4th Grade) and Up (###-###-####). If not applicable, please note n/a.

Child's Email Address for Programming Purposes Nitzaneem (3rd & 4th Grade) and Up. If not applicable, please note n/a.

* Child's Secular School as of September 2019

* Child's Secular Grade as of September 2019

* Please list a maximum of three participants with whom your child would like to be in a group. (We will do our best to factor these requests in with other considerations such as group size, gender balance and group dynamics.)

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.

CHAVAYA TUITION 2019 - 2020
Group	Actual Cost	Chavaya Tuition
Zera'eem (K)	$1210	Complimentary for all Zera'eem families
Shorasheem (1st and 2nd Grade)	$1210	$920
Nitzaneem (3rd and 4th Grade)	$1720	$1300
Ahleem (5th and 6th Grade)	$1720	$1300
Aytzeem (7th Grade)	$2745	$2080

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

In registering my child in the Chavaya program, I am making the financial commitment for the year. I understand that tuition is non-refundable after Tuesday, October 29th.

Please click that you understand that tuition is non-refundable after Tuesday, October 29th.

Zera'eem - Ahleem tuition includes the cost of Community Shabbat

Registration Options-You must select ONE of the four following options

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, the Chavaya Tuition to Temple Israel.

3. I would like to pay the Actual Cost over a 9 month period.

4. I would like to pay the Chavaya Tuition over a 9 month period.

Community Brit (Behavior Contract) and Technology Policy

* In addition to on-line registration, you will receive a physical mailing of our Chavaya Community Brit for each child registered. If your child is enrolled in 3rd - 7th grade, you will also receive a Technology Policy. These are guidelines for our participants and must be signed by both the child and parent(s) and returned to the office in order for registration to be considered complete.

I understand that we will need to sign and return these documents for registration to be complete.

Interested in Youth 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

Education & Youth Committees

I am interested in learning more about the committees that support education and youth group programs.

Chavaya Parent Snack Volunteers (for 3rd - 6th Grade)

On Tuesdays and Thursdays, Chavaya sells snack to the 3rd-6th grade children. In order to make this program successful, we need assistance from the parents. Please select ONE volunteer option below.

Option 1

I would like to help serve snacks from 2:50 - 4 pm

Tuesdays
Thursdays
Tuesdays or Thursdays

Option 2

I would like to provide snacks:

A volunteer schedule will be communicated to parents at the beginning of September.

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.

Please include information if your child has an IEP or 504 in place in their secular school as this information may be helpful in addressing their specific needs. This information will be kept confidential by the Chavaya Director, and will only be shared with the Faculty and Clergy as needed.

Medications that your child takes on a regular basis

Allergies (especially food allergies). Please be specific.

If your child uses an inhaler for asthma click here

Yes

If your child has food allergies and will need to keep an Epi-Pen in the office click here

Yes

I certify that my child is up to date on their vaccinations.

Yes

* Physician's Name (Last, First)

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

* Name of Insurance Company

* Insurance Company ID

* Policy #

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

Please click here to email a recent digital photograph of your child to the Chavaya Office at Chavaya@tinr.org A photograph will help your child's educator get to know your child before the year begins, and will enable us to identify your child in case of emergency. Your application will not be considered complete with out the emailed photograph.

Please note: file must be a JPEG, GIF or PNG format.

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

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