Dearreligiousschool Families

DearReligiousSchool Families,

Welcome to the 2015-2016 Religious School year. We are looking forward to sharing a year of learning, participation and involvement with you. Together, with your ongoing help and support of our programs, we will continue to provide a meaningful and fulfilling educational environment for our children.

We are gratified that we have been able to continue to put a strong and sound foundation into our school. As part of a new system, we will pre-register all of our students. Please see attached forms for more information.

We will continue to have a top notch faculty who will be spending a good amount of time during the summer planning for the upcoming year. Each year our Education Committee reviews and evaluates our ReligiousSchool program. We strive to continue to provide the best for our students and their families. Your willingness to register your child/ren early will allow us to plan the upcoming year even better.

If there are special circumstances with regard to payment, please contact one of the members of our Financial Arrangements committee, listed below or contact medirectly. We will make every effort to accommodate you.

I am available at any time, if you have any questions or concerns. Please do not hesitate to call me. I know the upcoming school year will be great for everyone. I look forward to hearing from you soon.

B'shalom,

Betsy Marantz

Supervisory Principal

Financial Arrangements Committee:

Janice Hoff, Treasurer or 860-633-4320

Judy Kulick, Exec VP or 860-659-3406

Phil Manaker or 860-659-4584

Registration Information and Schedule

Registration Dates / April 1-May 15 / May 15- August 1 / By August 31
Requirements / *Member in Good Standing can pre-register. / Open registration
*Member in Good Standing / Tuition payment due in full.
Minimum deposit $200 per child. Tuition payment made in full by check entitles you to a $25 Gift Card to Stop & Shop or ShopRite per child enrolled. (This does not include Nursery.) / Either payment in full or $200 deposit per child. / Note:
Individual arrangements for amounts or timing for payment adjustments are taken into account.

Gift Card request: ______Stop & Shop_____ShopRite

The completion of the attached registration information, medical information along with your payment will be required in order for your child/ren to attend religious school next Fall, 2015.

Registration fees

Nursery $ 165.00

Kindergarten – 2nd $ 590.00

3rd - 6th Grade $ 835.00

7th Grade$1,500.00 8th - 12th Grade $ 590.00

NOTE:We have determined that the average cost per child on an hourly basis is approximately $12.00. These hourly rates were determined by the number of weeks of religious school and the total yearly amount for the year. As you can see we have tried our best to keep the cost for religious education to a manageable rate while reinforcing the importance of and the value of supporting the Synagogue as we emphasize “from generation to generation”. In addition, our program offers a life-long connection to Jewish values and a quality Jewish life.

*To be a Member in Good Standing, you need to have paid 75% of your dues and tuition of the current year at the time of registration. This includes any arrangements.

KolHaverimReligiousSchool Registration Form 2015-2016

1079 Hebron Avenue, Glastonbury, Connecticut06033 Phone: (860) 633-3966

(Please fill out both forms for your child/ren being registered)

1. Student's Name:______Male___Female___

(Last)(First)(Middle)

What does this child prefer to be called?______Hebrew Name______

Birth date: ______Bar/Bat Mitzvah Date:______(only if scheduled)

Public/Private School attending as of 9/15: ______Grade as of 09/15: ______

Student E-mail Address______

Please list any information which will be helpful to the teacher and/or the Educational Staff of The Temple (medical, learning problems, etc.). This information will be kept confidential.

______

2. Student's Name:______Male___Female___

(Last)(First)(Middle)

What does this child prefer to be called?______Hebrew Name______

Birth date: ______Bar/Bat Mitzvah Date:______(only if scheduled)

Public/Private School attending as of 9/15: ______Grade as of 09/15: ______

Student E-mail Address______

Please list any information which will be helpful to the teacher and/or the Educational Staff of The Temple (medical, learning problems, etc.). This information will be kept confidential.

______

3. Student's Name:______Male___Female___ (Last) (First) (Middle)

What does this child prefer to be called?______Hebrew Name______

Birth date: ______Bar/Bat Mitzvah Date:______(only if scheduled)

Public/Private School attending as of 9/15: ______Grade as of 09/15: ______

Student E-mail Address______

Please list any information which will be helpful to the teacher and/or the Educational Staff of The Temple (medical, learning problems, etc.). This information will be kept confidential.

______

Home address: ______Zip code:______

City:______State:______Home Phone:______

Family E-mail Address______

E-mail Address:

Father's Name:______Work Phone: ______

Cell Phone:______Pager ______

Mother's Name: ______Work Phone: ______

Cell Phone:______Pager: ______

Occupations: Father ______Mother ______

If the student spends some weekends at a different address, give name, address & phone number:

Name:______Phone #: ______

Address:______Zip code: ______

E-mail Address:______

In case of emergency please notify: ______Phone: ______

Registration fees

Nursery $ 165.00______

Kindergarten – 2nd $ 590.00______

3rd - 6th Grade $ 835.00 ______

7th Grade$1,500.00 ______

8th - 12th Grade $ 590.00 ______

Total Deposit ______

Balance Due ______

__Enclosed is my check for payment in full.

__Enclosed is a deposit of $200.00 per student
2015 /2016 MEDICAL AUTHORIZATION AND RELEASE FORM

NAME OF STUDENT______Entering Grade ______

I ______authorize medical treatment of above minors when I cannot be contacted. Such medical treatment is to include, without limitation, x-ray examination, anesthetic, medical, dental or surgical examination or treatment and general hospital care. No prior determination of life-threatening emergency or danger of serious or permanent injury resulting from delay of treatment need be made under this authorization.

Except as indicated at the end of this paragraph, this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of the adult to give specific consent to any and all such examinations, treatment or hospital care.

(Exception: ______)

The possession of the original of this authorization by the adult is evidence that s/he has care and control of such minors and that I cannot be contacted.

I will indemnify and hold harmless from any expenses or claims of any nature any entity which provides or causes to be provided examination, treatment or hospital care pursuant to this authorization (except to the extent such entity is negligent therein) and conditionally agree to make or cause to be made, by assignment of third party benefits or otherwise, full and complete payment for such examination, treatment or hospital care.

I am the person having the power to consent to medical treatment of such minor.

Parent's Name:______Phone Number:______

Emergency Contact:______Phone Number: ______

Doctor's Name: ______Phone Number:______

Preferred Hospital:______

Insurance Carrier: ______Insurance #: ______

Allergies:______

I give my permission for my child to take trips with his/her class this year. I understand that the students will be supervised at all times. I give permission for my child to take part in any and all authorized activities of the ReligiousSchool, including trips that may be made away from Kol Haverim premises. I release the ReligiousSchool and Kol Haverim and its agents and employees from any liability for any accident in connection with these activities other than as a result of gross negligence of the ReligiousSchool or Kol Haverim and its agents and employees. I indemnify the ReligiousSchool and Kol Haverim from any loss or liability they may incur as a result of any damages or injuries caused by the student. For insurance purposes, we are required to have on file your driver's license # ______State of Issuance ______. I carry Liability Insurance Yes or No (Please circle one) This authorization shall remain effective for a period of one (1) religious school year, unless sooner revoked by the physical destruction of the original hereof, such destruction being the only method of actual notice of the revocation of same.

All blanks of this authorization were filled in before I signed this authorization.

Signature: ______Date: ______

Witness:______