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The Temple-Tifereth Israel Learning Center Registration and Payment Form 2017-2018


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




(Madrichim will fill out a separate preference form. The link will be included in your confirmation email.)









Why do we ask about Summer Camps? This helps us plan for the "One Happy Camper" scholarship program (managed by the JECC), as well as other possible scholarship funding. Thank you for answering this question!

Shabbaton Family Learning (Tots to 6th Grade) - Saturday afternoon
Sunday Learning (Pre-K to 7th Grade)
Monday Chai Learning (7th to 12th Grade)
Kallah Learning (8th to 12th Grade) - 4 hour intensive six times a year on the weekend.
Independent Learning (8th to 12th Grade)
Wednesday Learning (3rd to 6th Grade) $0.00
Parent Child Hebrew (3rd to 6th Grade) $35.00
Skype (3rd to 6th Grade) $125.00
7th Grade Hebrew Lab for those with Spring B'nai Mitzvah & any 7th Grader who wants to boost Hebrew Skills (Sunday 9:30-10:30 or Monday 5:30-6:30) FIRST SEMESTER ONLY $0.00
n/a $0.00
Shabbatots (Shabbaton only) $330.00
Pre-K $430.00
Kindergarten $430.00
1st Grade (includes $75 Consecration Fee) $530.00
2nd Grade $455.00
3rd Grade $490.00
4th Grade $490.00
5th Grade $490.00
6th Grade $490.00
7th Grade $430.00
8th Grade $400.00
9th Grade $400.00
10th Grade (Includes $325 Confirmation Fee) $725.00
11th Grade $400.00
12th Grade $400.00

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
n/a

(Madrichim will fill out a separate preference form. The link will be included in your confirmation email.)









Why do we ask about Summer Camps? This helps us plan for the "One Happy Camper" scholarship program (managed by the JECC), as well as other possible scholarship funding. Thank you for answering this question!

Shabbaton Family Learning (Tots to 6th Grade) - Saturday afternoon
Sunday Learning (Pre-K to 7th Grade)
Monday Chai Learning (7th to 12th Grade)
Kallah Learning (8th to 12th Grade) - 4 hour intensive six times a year on the weekend.
Independent Learning (8th to 12th Grade)
Wednesday Learning (3rd to 6th Grade) $0.00
Parent Child Hebrew (3rd to 6th Grade) $35.00
Skype (3rd to 6th Grade) $125.00
7th Grade Hebrew Lab for those with Spring B'nai Mitzvah & any 7th Grader who wants to boost Hebrew Skills (Sunday 9:30-10:30 or Monday 5:30-6:30) FIRST SEMESTER ONLY $0.00
n/a $0.00
Shabbatots (Shabbaton only) $330.00
Pre-K $430.00
Kindergarten $430.00
1st Grade (includes $75 Consecration Fee) $530.00
2nd Grade $455.00
3rd Grade $490.00
4th Grade $490.00
5th Grade $490.00
6th Grade $490.00
7th Grade $430.00
8th Grade $400.00
9th Grade $400.00
10th Grade (Includes $325 Confirmation Fee) $725.00
11th Grade $400.00
12th Grade $400.00

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
n/a

(Madrichim will fill out a separate preference form. The link will be included in your confirmation email.)









Why do we ask about Summer Camps? This helps us plan for the "One Happy Camper" scholarship program (managed by the JECC), as well as other possible scholarship funding. Thank you for answering this question!

Shabbaton Family Learning (Tots to 7th Grade) - Saturday afternoon
Sunday Learning (Pre-K to 6th Grade)
Monday Chai Learning (7th to 12th Grade)
Kallah Learning (8th to 12th Grade) - 4 hour intensive six times a year on the weekend.
Independent Learning (8th to 12th Grade)
Wednesday Learning $0.00
Parent Child Hebrew $35.00
Skype $125.00
7th Grade Hebrew Lab for those with Spring B'nai Mitzvah & any 7th Grader who wants to boost Hebrew Skills (Sunday 9:30-10:30 or Monday 5:30-6:30) FIRST SEMESTER ONLY $0.00
n/a $0.00
Shabbatots (Shabbaton only) $230.00
Pre-K $330.00
Kindergarten $330.00
1st Grade (includes $75 Consecration Fee) $430.00
2nd Grade $355.00
3rd Grade $390.00
4th Grade $390.00
5th Grade $390.00
6th Grade $390.00
7th Grade $330.00
8th Grade $300.00
9th Grade $300.00
10th Grade (Includes $325 Confirmation Fee) $625.00
11th Grade $300.00
12th Grade $300.00

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
n/a

(Madrichim will fill out a separate preference form. The link will be included in your confirmation email.)









Why do we ask about Summer Camps? This helps us plan for the "One Happy Camper" scholarship program (managed by the JECC), as well as other possible scholarship funding. Thank you for answering this question!

Shabbaton Family Learning (Tots to 7th Grade) - Saturday afternoon
Sunday Learning (Pre-K to 6th Grade)
Monday Chai Learning (7th to 12th Grade)
Kallah Learning (8th to 12th Grade) 4 hour intensive six times a year on the weekend.
Independent Learning (8th to 12th Grade)
Wednesday Learning (3rd to 6th Grade) $0.00
Parent Child Hebrew (3rd to 6th Grade) $35.00
Skype (3rd to 6th Grade) $125.00
7th Grade Hebrew Lab for those with Spring B'nai Mitzvah & any 7th Grader who wants to boost Hebrew Skills (Sunday 9:30-10:30 or Monday 5:30-6:30) FIRST SEMESTER ONLY $0.00
n/a $0.00
Shabbatots (Shabbaton only) $230.00
Pre-K $330.00
Kindergarten $330.00
1st Grade (includes $75 Consecration Fee) $430.00
2nd Grade $355.00
3rd Grade $390.00
4th Grade $390.00
5th Grade $390.00
6th Grade $390.00
7th Grade $330.00
8th Grade $300.00
9th Grade $300.00
10th Grade (Includes $325 Confirmation Fee) $625.00
11th Grade $300.00
12th Grade $300.00

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.)

$
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)

Account Details

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

Payment Information

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