2014-15 CBI Religious School Registration Form Welcome to CBI Religious School! *You must complete your 2014/15 CBI membership commitment BEFORE you can register your child(ren) for Religious School. Contact the CBI office at (434)2956382 if you have not completed your renewal for 2014/15. This form should be completed for children who were NOT enrolled in CBI Religious School during academic year 2013/14. Please fill out the information below and return it to the CBI Office, P.O. Box 320, Charlottesville, VA 2290, with your Membership Commitment Form by July 15. We look forward to seeing you at our first day of Religious School on Sunday, September 7th at 9:40AM. (please use a separate form for each child) Child’s Name: Gender: Child’s Hebrew Name: Birthdate: Male / Female / Grade in public/private school fall of 2014: Parent Name(s): Address: Home Phone: Mother’s Cell Phone: Father’s Cell Phone: Mother’s Email: Father’s Email: Emergency Contact: Phone: Health Insurance Company: Policy # Special Medical Information (allergies, medications, learning/behavioral difficulties, etc.): 2014/15 RELIGIOUS SCHOOL FEES Sunday only (grades K,1,2) – $425 Sunday and Wednesday - prayer Hebrew track (grades 3 – 7) – $800 Sunday and Ivrit B’Ivrit - conversational Hebrew track (grades 3 – 7) – $1550 Mitzvah Corp – Wednesdays (grade 8) –$350 Hebrew High School - Wednesdays (grades 9 – 12) - $350 BITY Youth Group Registration Fee – (grades 6 – 12) - $18 Hebrew Prayer or Ivrit B’Ivrit Hebrew Language track choice (for students in grade 3 – 7) Please check one: Hebrew Prayer Ivrit B’Ivrit Total Religious School/Hebrew School/BITY Charges: $ If you need to make special arrangements for tuition, please contact Rabbi Tom Gutherz, 295-6382. Voluntary Contribution: The tuition amount you pay is less than 50% of the actual cost of providing a Religious School education for your child. The remaining cost must be covered by fundraising and congregational support. We hope you will consider making an additional tax-deductible contribution. Please indicate your level of support: $200 $150 $100 Other: $_________ $75 $50 $25 Transfer the total for tuition and your donation to the Religious School to the Membership Commitment Form where you may indicate how you prefer to pay these commitments. Consent and Release: 1. This certifies that the undersigned, in the event of an emergency, does hereby grant permission for medical treatment to the child as ordered or recommended by a qualified attending physician. 2. Religious School and Youth Group activities sometimes require transportation. Your signature below allows the teacher, Youth Advisor or parent chaperone to drive and to assist in case of emergency. do/ do not give permission for photographs of and artwork by my child to be used by CBI 3. I Religious School and/or Youth Groups for promotional purposes. Parent Signature Date