Madrich/a Parent Form - Due by August 15, 2019 (*required, use NA if not applicable)

Madrichim - Madrichim serve as role models for our students, assistants to our teachers and essential help at The Temple-Tifereth Israel Learning Center. To be eligible for the Madrichim program you must attend Chai Learning with consistent attendance. 7th grade students who attend our Chai Learning program on Sundays are NOT eligible to be madrichim on Sundays. As a madrich/a, there are opportunities to work Saturdays, Sundays, or Wednesdays. Madrichim assist in learning spaces, the office or as specialists.

-Madrichim Orientation - Wednesday, August 28th 5:00-8:00pm. First time madrichim will meet at 5:00pm, returning Madrichim will join us at 6:00pm. Dinner provided.

Compensation - First year madrichim are not monetarily compensated. We will gladly sign any forms you may have to fulfill your community service hours for school or programs. Second year madrichim and above have the option to be paid. Madrichim receive compensation for the session they work (not by the hour).

Madrich/a Information

* Madrich/a Full Name, first and last

Parent/Guardian 1 Information

* Your First Name

* Your Last Name

* Your Cell Phone Number (include area code)

* Your Email Address

Parent/Guardian 2 Information (optional)

Your First Name

Your Last Name

Your Cell Phone Number (include area code)

Your Email Address

* I think my child will be a great Madrich/a because...

* Do you have any concerns about your child being a Madrich/a? Please explain.

* Has your child ever been asked to leave, suspended or expelled from any school, camp or extracurricular activity?

	No
	Yes

* If yes, please share relevant and helpful information with us.

(If asked to leave,suspended or expelled from any school, camp or extracurricular activity, there will be a meeting with the Director of Youth Engagement and Director of Learning to discuss the situation and create an individualized plan if necessary. Answering yes does not exclude application from consideration.)

* If my child is selected to participate in the Madrichim program: They will attend class weekly for the entire school year (at least 75% of classes)

	Yes, able to attend 75%
	No, not able to attend 75%
	My child will arrive 10 minutes before class begins, and will stay 5 minutes after class to help wrap up at the end of the day.
	I understand that as a Madrich/a my child is a role model to students and a responsible teammate to the teacher, therefore weekly and punctual attendance is crucial.
	If my child cannot make it, they will let Jamie Collins and their teacher know the week before their absence.

My virtual signature below confirms that both my child and I understand these expectations and will abide by them if selected to participate in the Madrichim program, and understand there are consequences for not abiding by these guidelines.

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*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

Comments

Increase the payment amount by 3% to cover credit card fees (No fee for Checking)

Total:

Madrich/a Parent Form - Due by August 15, 2019 (*required, use NA if not applicable)

Madrich/a Information

Parent/Guardian 1 Information

Parent/Guardian 2 Information (optional)

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

Madrich/a Parent Form - Due by August 15, 2019 (*required, use NA if not applicable)

Madrich/a Information

Parent/Guardian 1 Information

Parent/Guardian 2 Information (optional)

Account Details

Enter your name and e-mail address for your confirmation:

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

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