PS39 - After School and Ha’Geemnasia Registration Winter 2018-19

AS - Registration Information for PS39

Are you a CBE temple member?

Temple Member?

Yes No

Student First Name *

Student Last Name *

Parent Email Address *

Grade *

School *

Gender *

Street Address *

City *

State *

Postal Code *

Registration Fees

Sibling Discount instruction:

If you are registering more than one child within the same household, you are eligible to receive a 5% discount on After School care for all children after you have paid the full price of tuition for the first child. In order to receive this discount, you should fill out the same form and email Lisa Wolf at lwolf@cbebk.org for a 5% refund after payment has been received. If needed, payment can be processed manually if you prefer to pay the discounted amount instead of waiting for a refund. Please contact Lisa Wolf at lwolf@cbebk.org for this option.

CBE Members: # of Days Attending

One Full Day - $ 615.00

Two Full Days - $ 910.00

Three Full Days - $ 1,185.00

Four Full Days - $ 1,345.00

Five Full Days - $ 1,485.00

- none -

*PLEASE NOTE: If you are registering to both After School AND Ha'Geemnasia you need to choose one of the After School + Ha'Geemnasia options above AND one of the Ha'Geemnasia options below. *If you are registering just for Ha'Geemnasia please select only from the options below. *If you are not sure please email Lisa Wolf (After School) lwolf@cbebk.org or Alex Ben-Abba (Ha'Geemnasia) hageemnasia@cbebk.org

CBE Members: # of Single Classes Attending

1 class - $ 355.00 2 classes - $ 715.00 3 Classes - $ 1,070.00

HA'GEEMNASIA - CBE Members: # of Days for

PLEASE NOTE: Ha'Geemnasia hours are - K-1st 3:45-5:45 PM 2nd-3rd 3:45-5:45 PM

CBE NON Members: # of Days Attending

One Full Day - $ 660.00

Two Full Days - $ 1,025.00

Three Full Days - $ 1,330.00

Four Full Days - $ 1,510.00

Five Full Days - $ 1,655.00

- none -

CBE NON Members: # of Single Classes Attending

1 Class - $ 485.00

2 Classes - $ 975.00

3 Classes - $ 1,465.00

HA'GEEMNASIA - NON Members: # of Days

PLEASE NOTE: Ha'Geemnasia hours are - K-1st 3:45-5:45 PM 2nd-3rd 3:45-5:45 PM

Additional Fee Courses

Toy Making - $ 50.00 Super Soccer - $ 75.00

Destroy And Construct - $ 50.00 Make a Musical: NYC Kids - $ 125.00

Shakespeare Players - $ 125.00 Ice Skating - $ 225.00

Please reconfirm your selection in the choices below.

Convenience Fee

The total price includes a 1.5% convenience fee

Registration Fee *

Registration Fee - $ 25.00

Registration Fee Hebrew Programming - $ 25.00

*If you are registering for BOTH After School and Ha'Geemnasia, please check both options above. *A 1.5 percent convenience fee will be added to your total.

Total Fee(s)

Credit Card Information

Card Type

Card Number *

Security Code *

Expiration Date *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Middle Name

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

AS - Course Selection - PS39 Winter 2018-19

Winter Term Days

Monday

Tuesday

Wednesday

Thursday

Friday

Winter Term Single Class

Monday Tuesday Wednesday Thursday Friday

PS39 - Winter 18-19 Monday 1st Choice

PS39 - Winter 18-19 Monday 2ndChoice

PS39 - Winter 18-19 Tuesday 1st Choice

PS39 - Winter 18-19 Tuesday 2ndChoice

PS39 - Winter 18-19 Wednesday 1st Choice

PS39 - Winter 18-19 Wednesday 2nd Choice

PS39 - Winter 18-19 Thursday 1st Choice

PS39 - Winter 18-19 Thursday 2nd Choice

PS39 - Winter 18-19 Friday 1st Choice

PS39 - Winter 18-19 Friday 2nd Choice

AS - Pick Up Person

The following person(s) is authorized to pick my child up from After School.

Pick Up Contact 1 - Name

Pick Up Contact 1 - Cell Phone

Pick Up Contact 2 - Name

Pick Up Contact 2 - Cell Phone

Pick Up Contact 3 - Name

Pick Up Contact 3 - Cell Phone:

End of the day dismissal options *

AS - Parents/Guardians

Parent/Guardian 1 Name *

Parent/Guardian 1 Primary email *

Parent/Guardian 1 Home Phone *

Parent/Guardian 1 Work Phone

Parent/Guardian 1 Cell Phone *

Parent/Guardian 2 Name

Parent/Guardian 2 Primary email

Parent/Guardian 2 Home Phone

Parent/Guardian 2 Work Phone

Parent/Guardian 2 Cell Phone

AS - Emergency Information

Allergies? *

Yes No

If yes, please specify allergies and action to take:

Medication? *

Yes No

If yes, please specify:

AS - Signature

Please type your full name to sign the form and agree to the terms and conditions.

Electronic Signature *

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PS39 - After School and Ha’Geemnasia Registration Winter 2018-19

Before submitting your registration, please verify your selections and the total amount to be paid.