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The Temple-Tifereth Israel Learning Center Registration and Payment Form 2019-2020


Please complete this form on a computer (not a cell phone or tablet). Many sections of this form have required fields denoted with an asterisk (*). If you are having trouble submitting this form please check all sections for missing required information. The missing information will be highlighted in light red.

Parent/Guardian 1 Information (Note: contains required fields)

All required fields have an asterisk (*). All fields must be filled in to be able to submit this form.

Please enter at least one phone number below and type "n/a" in any that do not apply.







Parent/Guardian 2 (Note: contains required fields. If not applicable please type n/a in all fields)

All required fields have an asterisk (*). All fields must be filled in to be able to submit this form.

Please enter at least one phone number below and type "n/a" in any that do not apply.

Emergency Contact Information (Note: contains required fields)

All required fields have an asterisk (*). All fields must be filled in to be able to submit this form.

Our policy is to call parents or guardians listed above first. We kindly request that you provide two emergency contacts in case you are not available.

Learner 1 Information

Yes
No
Yes
No
Yes
No
Easily
Fairly well
With difficulty

We ask about Summer Camps to help us plan for the "One Happy Camper" scholarship program (managed by the Jewish Education Center of Cle), as well as other possible scholarship funding here at Temple.

Please note that you will be billed a $525 B'nai Mitzvah fee separately one year prior to your child's B'nai Mitzvah date.

Learner 2 Information

Yes
No
Yes
No
Yes
No
Easily
Fairly well
With difficulty

We ask about Summer Camps to help us plan for the "One Happy Camper" scholarship program (managed by the Jewish Education Center of Cle), as well as other possible scholarship funding here at Temple.

Please note that you will be billed a $525 B'nai Mitzvah fee separately one year prior to your child's B'nai Mitzvah date.

Learner 3 Information

Yes
No
Yes
No
Yes
No
Easily
Fairly well
With diffuculty

We ask about Summer Camps to help us plan for the "One Happy Camper" scholarship program (managed by the Jewish Education Center of Cle), as well as other possible scholarship funding here at Temple.

Please note that you will be billed a $525 B'nai Mitzvah fee separately one year prior to your child's B'nai Mitzvah date.

Learner 4 Information

Yes
No
Yes
No
Yes
No
Easily
Fairly well
With difficutly

We ask about Summer Camps to help us plan for the "One Happy Camper" scholarship program (managed by the Jewish Education Center of Cle), as well as other possible scholarship funding here at Temple.

Please note that you will be billed a $525 B'nai Mitzvah fee separately one year prior to your child's B'nai Mitzvah date.

Learner 5 Information

Yes
No
Yes
No
Yes
No
Easily
Fairly well
With difficulty

We ask about Summer Camps to help us plan for the "One Happy Camper" scholarship program (managed by the Jewish Education Center of Cle), as well as other possible scholarship funding here at Temple.

Please note that you will be billed a $525 B'nai Mitzvah fee separately one year prior to your child's B'nai Mitzvah date.

Permissions, Consents, Donations, and Payments (Note: contains required fields)

All required fields have an asterisk (*). All fields must be filled in to be able to submit this form.










(type n/a if you clicked Yes or No above)



(Type "n/a" if you DID give consent.)

Type n/a if this does not apply to your child/(ren).




$
No $0.00
Yes $36.00
1. I will be paying online through this form (1,2, or 3 monthly payment options are available below the "Comments" section)
2. I will contact the Finance Office to set up a payment plan. Call (216) 831-3233 and ask for Suzanne or Lana
3. I will send my payment by check (1 check now)
4. I will send my payment by check (2 checks - 1 now and 1 next month)
5. I will send my payment by check (3 checks - 1 now, 1 next month, and 1 the following month)

Selecting "No" means you will pay now through this form. Selecting "Yes" means you will use one of the other payment options.

Account Details

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

Payment Information

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

For added Security please check the box below.