Kulanu Registration Form

Kulanu at the Orangetown Jewish Center

As we move into our second year of Kulanu we are so thankful to have you as part of our community. We have learned so much in the past year and are expanding and changing the program in ways that will be beneficial to all of our Kulanu students and families. In order to do this in the best way possible, we are asking you to register early. Please submit your registration form and non-refundable $150 deposit (applied to tuition costs) as soon as you can. Scholarships are available. To apply, please submit your form by June 26st and email Rabbi Scheff at rabbi.scheff@theojc.org. After June 26th, no discounts or scholarships are available.
Next Steps

1. Complete the registration form with your child (ren)’s information. 2. Mail your deposit to the synagogue: 8 Independence Ave., Orangeburg, NY 10962 3. As needed, contact Rabbi Scheff to apply for a scholarship.
Deposit

Your non-refundable deposit must be received and your OJC financial obligations must be rectified before your registration is processed. If you have questions please contact Helen Barnett, OJC Bookkeeper, at 845-359-5920.
Tuition

Listed below are the tuition rates by grade for the 2020-2021 school year for both OJC members, and non-members. Tuition includes books, supplies, snacks and special programming:
Kindergarten

Free regardless of registration date, and membership status. However, please register as soon as possible to aid us in planning for the fall.
1st Grade

$575/student if received by June 26, 2020. $675/student after 6/26. Non-member surcharge: $775/student.
2nd Grade

$575/student if received by June 26, 2020. $675/student after 6/26. Membership is required.
Grade 3-7

$900/student if received by June 26, 2020. $1000/student after 6/26. Membership is required.
Kulanu Meeting Times

All students in grades K-7 will meet on Tuesdays, 4:15-6:15. Students in grades 3-7 will also meet Thursdays, 4:15-6:15. Additionally, there will be monthly family education programs run by Rabbi Drill on Sundays, 9:30-11:30.
Reminder

Registration is complete when your deposit is received, OJC financial obligations are paid in full and Kulanu forms are complete. We look forward to having your child(ren) attend Kulanu in the fall!
Contact

If you have any questions please contact Rabbi Miriam Midlarsky Lichtenfeld, Educational Director: kulanu@theojc.org or at 845-359-5920, ext. 9

Student #1 Registration Form
Student #1 Name *

First Name Middle Name Last Name
Hebrew Name *
Birth Date *

Month Day Year
Preferred Pronoun
Student's Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Student's Secular School *
Student's Grade for 2020-2021 *
Student #1 Allergies/ Health Concerns
Student #1 Medications
Does your student have either of these learning modifications?

IEP 504
Is there anything you would like to tell us about the way your child learns best?
Student #2 Registration Form

Fill out the form carefully for registration
Student #2 Name

First Name Middle Name Last Name
Hebrew Name
Birth Date

Month Day Year
Preferred Pronoun
Student's Address (only if different from other students)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student's Secular School
Student's Grade for 2020-2021
Student #2 Allergies/ Health Concerns
Student #2 Medications
Does your student have either of these learning modifications?

IEP 504
Is there anything you would like to tell us about the way your child learns best?
Student #3 Registration Form

Fill out the form carefully for registration
Student #3 Name

First Name Middle Name Last Name
Hebrew Name
Birth Date

Month Day Year
Preferred Pronoun
Student's Address (only if different from other students)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Student's Grade for 2020-2021
Student's Secular School
Student #3 Allergies/ Health Concerns
Student #3 Medications
Does your student have either of these learning modifications?

IEP 504
Is there anything we should know about the way your child learns best?

Parent/Guardian #1 Information
Name *

First Name Last Name
Email *
example@example.com
Phone Number *

Area Code Phone Number
Address (Only if it differs from student's)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent/Guardian #2 Information
Name

First Name Last Name
Email
example@example.com
Phone Number

Area Code Phone Number
Address (Only if it differs from Students')

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code

Pick Up #1
Name

First Name Last Name
Relationship
Phone Number

Area Code Phone Number
Pick up #2
Name

First Name Last Name
Relationship to student
Phone Number

Area Code Phone Number
Pick Up #3
Name

First Name Last Name
Relationship To student
Phone Number

Area Code Phone Number

Consents

(Please check all consents you approve.)
If you wish to rescind this agreement, you may do so at any time in writing to the Educational Director and rescission will take effect upon receipt by the school.

I GRANT permission for a photo/image of this student to be published in the newspaper and on the school or synagogue website. (This may include personally identifiable information such as student name.) I GRANT permission for my child to participate in OJC Kulanu trips during this school year. I, the undersigned, on behalf of myself and my child, hereby expressly release and discharge teachers, employees and members of the Orangetown Jewish Center from any and all causes of actions, claims, damages and other liabilities. I GRANT permission for my name, address, phone number and email to be printed in the school directory/class list.

Medical and Emergency Information

(please use child’s name to specify who you are writing about)Please fill out the below information for all students you will be registering for the 2020/2021 school year.
Are there any special family situations of which you would like us to be aware?
Is there anything else you would like us to know about your child(ren)?
Emergency Contacts

Note: in the event of an emergency, those listed below will only be contacted in the event that a primary caregiver cannot be reached.
Emergency Contact #1 Name *

First Name Last Name
Emergency Contact #1 Phone Number *

Area Code Phone Number
Emergency Contact #2 Name *

First Name Last Name
Emergency Contact #2 Phone Number *

Area Code Phone Number
Today's Date

Month Day Year
Date
Reminder: Please send your $150 deposit to the Orangetown Jewish Center: 8 Independence Ave, Orangeburg, NY 10962
Parent or Guardian Signature: In order to sign, use your trackpad, touchscreen, or mouse.

Clear
Should be Empty:

Kulanu at the Orangetown Jewish Center

Next Steps

Deposit

Tuition

Kindergarten

1st Grade

2nd Grade

Grade 3-7

Kulanu Meeting Times

Reminder

Contact

Student #1 Registration Form

Student #2 Registration Form

Student #3 Registration Form

Parent/Guardian #1 Information

Parent/Guardian #2 Information

Pick Up #1

Pick up #2

Pick Up #3

Consents

Medical and Emergency Information

Emergency Contacts

Reminder: Please send your $150 deposit to the Orangetown Jewish Center: 8 Independence Ave, Orangeburg, NY 10962