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Chai School Registration

High School Program for Grades 8-12
Registration Forms 2019-2020

LAST NAME:

If last names are different, put Student/Parent last names.

PLEASE NOTE: online registration requires online payment. If you do not want to make a payment online and will mail in your payment before the August 1st deadline, select yes under scholarship. The will zero out your amount due.

Complete all tabs before making a payment.

SCHOOL FEES

Weekly/Monthly Courses Grades 9-12

Enter the number of students.

Weekly/Monthly Courses Grade 8

Enter the number of students.

Vitrual Chai School

Enter the number of students.

Confirmation

Enter the number of students. This fee includes the Confirmation Class trip L'Taken to Washington DC and Weekly/Monthly Courses.

Online Judaic Studies

Enter number of students

Late Fee for registrations submitted after August 1st deadline.

Late Fee $30.00

SCHOLARSHIP OR MAIL IN PAYMENT

Select yes if you are requesting a scholarship OR if you do not want to pay online and will mail in your payment before the August 1st deadline. Payments received after August 1st you will be charged a late fee.

FAMILY INFORMATION

Information for Parent 1

Full Name:

Home Address:

Home Phone:

Work Phone:

Cell Phone:

E-Mail:

Information for Parent 2

Full Name:

Home Address:

Home Phone:

Work Phone:

Cell Phone:

E-Mail:

Emergency Contact (if parents can’t be reached)

Name

Address

Phone (indicate cell or home)

Relationship to Students:

In case of an emergency, which hospital would you prefer?

Social Media Policy

Photo Use/Social Media Policy - Ck yes if you read this information:

Yes

STUDENT 1

Student Name

Course Selection

Download Catalogue https://cgoh.org/chai-school/

WEEKLY/MONTHLY COURSES: Select as many as you want.

Better Together

Children at the Well

The Jewish Lens

Cook it

EmpowHER

The Book Of Judges

The Artistic Studio

Witness Theater

So you Want to Be A Jewish Camp Counselor?

CGOH Community Youth Foundationn

J-Serve

Seeds of Justice Fellowship

Blog, Tweet, Snap!

Hebrew for Travel

VITRUAL CHAI SCHOOL: Select one class.

Digital Citizenship and Jewish Values

Preparing for Life On Campus

Introduction to Jewish History: 1700-Modern Israel

ONLINE JUDAIC STUDIES:Select one class.

Experiencing Jewish Text and Identity through the ARts

Practical Ethics for Living a Meaningful Life: A Jewish Approach

MOdern Jewish Short Stories

Student 1 information

Student's Date of Birth

Student's High School and District

Student's Grade in School This Fall

Student's Email Address

Student's Cell Number

Does your child have any conditions that might affect the students ability to work at grade level or participate in educational/social programs at Chai School or discribe anything that might assit the staff in planning your child's education:

Does child have an IEP or 504 plan? If yes, please give Arnie Rotenberg a copy.

Yes

If yes, what is the diagnosis?

Describe any services student receives in school or through the school district:

Any required accommodations?

Any medical conditions or allergies?

Does your child take any prescription medications regularly?

list meds

Doctor's Name/Phone

I give permission for Chai School staff to assist my student with the administration of the Epipen prescribed. A copy of the perscription is attached.

Yes

Covenant for Learning - Brit Limmud

Chai School Contract Brit Limud: Chai School is firmly committed to providing and promoting a Jewish educational atmosphere where all students are able to thrive in their Jewish learning. The conduct which we promote is based upon mutual respect and a sense of personal well-being, where each person treats others with Kavod (honor and respect). This implies that: Each person will arrive prepared to participate and learn. Each person will respect their peers and educators and recognize educators as authority figures. Each person is responsible for their own behavior and will strive to make decisions that respect the rights and property of others. Each person recognizes the sanctity of the temple and will behave appropriately and respectfully throughout the building. Each person recognizes that everyone has the right to: o Feel safe o Be respected o Be able to learn to the best of his/her ability o Be treated fairly irrespective of race, gender, physical characteristics, sexual orientation, or any other factors. I recognize that if I fail to comply with the following rules that I will be asked to leave Chai School and/or further punishment will be the responsibility of the Educator and Rabbi. I recognize that actions that will not be tolerated include: The possession or use of weapons or anything that may be construed as a weapon into the building or any program. The possession, distribution, or use of any illegal drug or drug paraphernalia. The possession, distribution, or use of any alcoholic beverages other than those served by an educator for Jewish sacramental purposes. Any dress that is not appropriate (i.e. not respectful or modest) for our Temple. The participation in any activity that is deemed as sexual or sexual harassment. The participation in any activity that is seen as demeaning or hurtful towards others. The participation in any activity that is seen as threatening towards others or makes others uncomfortable or upset I understand that this code of conduct is compliant at all times during the course of Chai School and if I fail to comply with the above terms there will be appropriate consequences. If a student violates the brit limmud in such a manner that the student is dangerous to himself/herself, others, or destroying property, the student's actions will be immediately reviewed with the parents. The Educator and Rabbi will determine, with the parents, under what conditions, if any, the child can continue participation in the school.

Student Name

to act as signature

Parent Name

To act as signature

STUDENT 2

Student Name

Course Selection

Download Catalogue https://cgoh.org/chai-school/

WEEKLY/MONTHLY COURSES: Select as many as you want.

Better Together

Children at the Well

The Jewish Lens

Cook it

EmpowHER

The Book Of Judges

The Artistic Studio

Witness Theater

So you Want to Be A Jewish Camp Counselor?

CGOH Community Youth Foundationn

J-Serve

Seeds of Justice Fellowship

Blog, Tweet, Snap!

Hebrew for Travel

VITRUAL CHAI SCHOOL: Select one class.

Digital Citizenship and Jewish Values

Preparing for Life On Campus

Introduction to Jewish History: 1700-Modern Israel

ONLINE JUDAIC STUDIES:Select one class.

Experiencing Jewish Text and Identity through the ARts

Practical Ethics for Living a Meaningful Life: A Jewish Approach

MOdern Jewish Short Stories

Student 2 information

Student's Date of Birth

Student's High School and District

Student's Grade in School This Fall

Student's Email Address

Student's Cell Number

Does child have an IEP or 504 plan? If yes, please give Arnie Rotenberg a copy.

Yes

If yes, what is the diagnosis?

Describe any services student receives in school or through the school district:

Any required accommodations?

Any medical conditions or allergies?

Does your child take any prescription medications regularly?

list meds

Doctor's Name/Phone

I give permission for Chai School staff to assist my student with the administration of the Epipen prescribed. A copy of the perscription is attached.

Yes

Covenant for Learning - Brit Limmud

Student Name

to act as signature

Parent Name

To act as signature

STUDENT 3

Student Name

Course Selection

Download Catalogue https://cgoh.org/chai-school/

WEEKLY/MONTHLY COURSES: Select as many as you want.

Better Together

Children at the Well

The Jewish Lens

Cook it

EmpowHER

The Book Of Judges

The Artistic Studio

Witness Theater

So you Want to Be A Jewish Camp Counselor?

CGOH Community Youth Foundationn

J-Serve

Seeds of Justice Fellowship

Blog, Tweet, Snap!

Hebrew for Travel

VITRUAL CHAI SCHOOL: Select one class.

Digital Citizenship and Jewish Values

Preparing for Life On Campus

Introduction to Jewish History: 1700-Modern Israel

ONLINE JUDAIC STUDIES:Select one class.

Experiencing Jewish Text and Identity through the ARts

Practical Ethics for Living a Meaningful Life: A Jewish Approach

MOdern Jewish Short Stories

Student 3 Information

Student's Date of Birth

Student's High School and District

Student's Grade In School This Fall

Students email

Students cell

Does child have an IEP or 504 plan? If yes, please give Arnie Rotenberg a copy.

Yes

If yes, what is the diagnosis?

Discribe any special services that your child receives in school or through the school district:

Any required accommodations?

Does your child have any medical problems or food allergies?

Does your child take any prescription medications regularly?

list meds

Doctor's Name/Phone:

I give permission for Chai School staff to assist my student with the administration of the Epipen prescribed. A copy of the perscription is attached.

Yes

Covenant for Learning - Brit Limmud

Chai School Contract Brit Limud: Chai School is firmly committed to providing and promoting a Jewish educational atmosphere where all students are able to thrive in their Jewish learning. The conduct which we promote is based upon mutual respect and a sense of personal well-being, where each person treats others with Kavod (honor and respect). This implies that: Each person will arrive prepared to participate and learn. Each person will respect their peers and educators and recognize educators as authority figures â¢ Each person is responsible for their own behavior and will strive to make decisions that respect the rights and property of others â¢ Each person recognizes the sanctity of the temple and will behave appropriately and respectfully throughout the building â¢ Each person recognizes that everyone has the right to: o Feel safe o Be respected o Be able to learn to the best of his/her ability o Be treated fairly irrespective of race, gender, physical characteristics, sexual orientation, or any other factors. I recognize that if I fail to comply with the following rules that I will be asked to leave Kolel and/or further punishment will be the responsibility of the Educator and Rabbi. I recognize that actions that will not be tolerated include: â¢ The possession or use of weapons or anything that may be construed as a weapon into the building or any program â¢ The possession, distribution, or use of any illegal drug or drug paraphernalia â¢ The possession, distribution, or use of any alcoholic beverages other than those served by an educator for Jewish sacramental purposes â¢ Any dress that is not appropriate (i.e. not respectful or modest) for our Temple. â¢ The participation in any activity that is deemed as sexual or sexual harassment â¢ The participation in any activity that is seen as demeaning or hurtful towards others â¢ The participation in any activity that is seen as threatening towards others or makes others uncomfortable or upset I understand that this code of conduct is compliant at all times during the course of Kolel and if I fail to comply with the above terms there will be appropriate consequences. If a student violates the brit limmud in such a manner that the student is dangerous to himself/herself, others, or destroying property, the studentâs actions will be immediately reviewed with the parents. The Educator and Rabbi will determine, with the parents, under what conditions, if any, the child can continue participation in the school.

Student's Name

to act as a signature

Parent's Name

to act as a signature

Payment due in full. Click yes if you want to set up 3 equal payments.

Recurring Payment

Payment is due in full at the time of registration. However, you may set up 3 recurring payments that will be charged to your cc/withdrawn from checking acct July, Aug. & Sept. (or monthly depending what month you submit your registration).

I want to make a recurring payment

Please enter the number of periods

Please bill me each period in the amount of

I agree to have my account information used to bill me as per the terms above. Additional payments will be made until the total number of periods are reached.

Recurring Total:

Account Details

E-mail

Enter your name and e-mail address for your confirmation

First Name

Last Name

Payment Information

Account

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Checking Account

Name on the Account

Bank Name

Routing Number

Is usually located between the symbols on your check.

Account Number

Typically comes before the symbols. Its exact location and number of digits varies from bank to bank.

Confirm Account Number

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

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