2017-2018 Teen Programming Registration

Keshet, Confirmation and Davis Reform Temple Youth (DRTY)

Please note that this form alone does not suffice as enrollment in Teen Programming. This form AND the 2017-2018 Emergency Medical Information Form available here (completed for each teen you're enrolling) must both be received for your teen(s)'s enrollment to be complete.

The registration deadline is Wednesday, September 27, 2017 for families returning to the programs, in order to avoid a $25 per student late fee. New families will not be assessed a late fee for registration after that date.

If you have questions about registration, please contact the CBH office by clicking here, or phoning 530-758-0842. If you have questions about the Keshet, Confirmation or DRTY programs, please contact Education Director Ardyth Sokoler by clicking her name, or phoning 530-758-0842.

Be sure to click the green "Submit" button when your form is complete, and await the "Thank you" acknowledgment page to ensure that your registration is received.

Email address of parent completing form Program-related communications will be sent to this address

Email address of additional parent Program-related communications will be sent to this address

Name of parent(s) responsible for program tuition payment

Mailing address for parent(s) listed above Program-related communications will be sent to this address

Mobile phone - parent completing form

Home phone If different than mobile phone listed above

Mobile phone - additional parent

Program roster opt-out Please check this box only if you do NOT wish for the address, emails and phone numbers provided above to appear in the program roster.

Name of parent in additional household, if applicable

Additional household contact information, if applicable Mailing address and home phone

Additional household - program roster opt-out Please check this box only if you do NOT wish for the contact information for this household to appear in the program roster.

Teens' registration information Click the "+" icon on the right of the first row to add a new row for each additional teen. 8th and 9th grade registrations will be directed toward the Keshet program; 10th grade or above will be directed toward the Confirmation program. All teens 8th - 12th grades are welcome to register to participate in DRTY, and DRTY may be selected separately from the Keshet/Confirmation programs.

Last Name	First Name	School grade as of 9/1/17	Place "x" in box for Keshet class	Place "x" in box for Confirmation class	Place "x" in box for DRTY participation

Add new row

Please check to indicate your understanding that registration is NOT complete until an Emergency Medical Information Form is completed for each teen you're enrolling Form is available for online submission at: http://www.bethaverim.org/education/religious-school/emergency-medical-information-1718

Tuition calculation Full amount of tuition will be calculated; the approval of any requested Financial Assistance will be applied toward the balance due at a later date. See section below for assistance application instructions.

# of Keshet/Confirmation students at $400 each

# of DRTY participants at $154 each This fee includes ALL 12 events on the DRTY calendar as of 9/1/17, with no additional funds due. Should a teen choose to engage on a program-by-program basis, events will be $25/each, to be collected at the time of RSVP.

Additional Voluntary Donation To enhance Education and Youth programs at CBH (#.##).

Total Amount

Signature By typing my name into the box below, I hereby agree to pay the charges above (+ a $25 late fee, per child, if registration completed after September 27, 2017) by April 30, 2018

Payment options Please check the applicable box below to indicate your payment plans. Your full or initial payment may be made NOW at https://www.bethaverim.org/about-us/make-a-donation/donationspayments, or by delivering a check or cash to the CBH office by Wednesday, September 27, 2017.

Payment in full by September 27, 2017
Pay 50% now and the balance by December 1, 2017
Pay 25% now and make quarterly payments on or before October 2, 2017, January 2, 2018 and April 2, 2018.
Make equal monthly payments, beginning on or before September 27, 2017

Teen Programming Tuition Policy Statement

Families seeking a tuition reduction must submit a confidential financial assistance request to Executive Director MK Menard by clicking here prior to the beginning of the school year. No teen will be refused entrance because of an inability to pay the standard tuition.

Sections

2017-2018 Teen Programming Registration