Central Reform Congregation Religious School Registration 2022-2023

CRC Religious School Registration 2022-2023

Current CRC membership in good standing is required in order to register children in CRC Religious School.
Please fill out this form completely and

click on the "Submit" button.

If you have already submitted the registration form
and wish to make a tuition payment,
click here to submit your payment information.
I am registering the following number of children for the CRC Religious School 2022-2023 school year: *

1 2 3 4
Student Information
STUDENT 1 NAME

First Name Last Name
Nickname
Student 1 Hebrew Name
Birth Date

Month Day Year
Grade Entering
Secular School and School District
If Student 1 is entering 7-10 grade, please provide their personal email address, if any
example@example.com
If Student 1 is entering 7-10 grade, please provide their personal cell phone number, if any

Area Code Phone Number
STUDENT 2 NAME

First Name Last Name
Nickname
Student 2 Hebrew Name
Birth Date

Month Day Year
Grade Entering
Secular School and School District
If Student 2 is entering 7-10 grade, please provide their personal email address, if any
example@example.com
If Student 2 is entering 7-10 grade, please provide their personal cell phone number, if any

Area Code Phone Number
STUDENT 3 NAME

First Name Last Name
Nickname
Student 3 Hebrew Name
Birth Date

Month Day Year
Grade Entering
Secular School and School District
If Student 3 is entering 7-10 grade, please provide their personal email address, if any
example@example.com
If Student 3 is entering 7-10 grade, please provide their personal cell phone number, if any

Area Code Phone Number
STUDENT 4 NAME

First Name Last Name
Nickname
Student 4 Hebrew Name
Birth Date

Month Day Year
Grade Entering
Secular School and School District
If Student 4 is entering 7-10 grade, please provide their personal email address, if any
example@example.com
If Student 4 is entering 7-10 grade, please provide their personal cell phone number, if any

Area Code Phone Number

Parent Information
PARENT 1 NAME

First Name Last Name
Parent 1 Address - ONLY IF DIFFERENT FROM LAST YEAR

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent 1 Home Phone - ONLY IF DIFFERENT FROM LAST YEAR

Area Code Phone Number
Parent 1 Cell Phone (This is how we will contact you in case of emergency. Please enter your cell phone number, even if unchanged.) *

Area Code Phone Number
Parent 1 Work Phone - ONLY IF DIFFERENT FROM LAST YEAR

Area Code Phone Number
Parent 1 Email (This will be our main form of communication during the school year. Please enter your email address even if unchanged.) *
example@example.com
You may contact me to volunteer during the school year:
PARENT 2 NAME

First Name Last Name
Parent 2 Address (ONLY IF DIFFERENT FROM PARENT 1)

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code
Parent 2 Home Phone - ONLY IF DIFFERENT FROM LAST YEAR

Area Code Phone Number
Parent 2 Cell Phone

Area Code Phone Number
Parent 2 Work Phone - ONLY IF DIFFERENT FROM LAST YEAR

Area Code Phone Number
Parent 2 Email
You may contact me to volunteer during the school year:
Student(s) live with:
Information goes to:
Social Media Permission
I grant permission to CRC to use photos and videos of my child(ren) participating in school activities in publications and on social media *

Student Medical Records 2020-2021

This section MUST be filled out completely for EACH student
Emergency Contact (OTHER THAN A PARENT) *

First Name Last Name
Emergency Contact Phone Number *

Area Code Phone Number
Emergency Contact's Relationship to Child(ren)
Physician name
Physician Phone Number
STUDENT 1 NAME

First Name Last Name
PARENT INSIGHT: Please tell us how student 1 learns best, what concerns you may have, and any other information you want to share.
Student 1 food allergies or health issues we should be aware of. (This is a required field. Please enter N/A if none.)
Student 1 Medications (This is a required field. Please enter N/A if none.)
STUDENT 2 NAME

First Name Last Name
PARENT INSIGHT: Please tell us how student 2 learns best, what concerns you may have, and any other information you want to share.
Student 2 food allergies or health issues that we should be aware of. (This is a required field. Please enter N/A if none.)
Student 2 Medications (This is a required field. Please enter N/A if none.)
STUDENT 3 NAME

First Name Last Name
PARENT INSIGHT: Please tell us how student 3 learns best, what concerns you may have, and any other information you want to share.
Student 3 food allergies or health issues we should be aware of. (This is a required field. Please enter N/A if none.)
Student 3 Medications (This is a required field. Please enter N/A if none.)
STUDENT 4 NAME

First Name Last Name
PARENT INSIGHT: Please tell us how student 4 learns best, what concerns you may have, and any other information you want to share.
Student 4 food allergies or health issues that we should be aware of. (This is a required field. Please enter N/A if none.)
Student 4 Medications (This is a required field. Please enter N/A if none.)
This is to certify that if the student(s) above should become ill, or have an accident that requires emergency medical care, and the Director or Principal is unable to reach the parent/guardian or the emergency contact listed above, the Director or Principal has permission to take necessary action.
Type your name as your electronic signature *

CRC Religious School Tuition Agreement

2021-2022 School Year

Your generous donations help us keep tuition affordable for all.

	Actual Cost	FULL TUITION
Rainbow	$350	no charge
PreK - 2nd	$850	$575
3rd - 6th	$1450	$875
7th	$650	included in B'nai Mitzvah fee
8th	$650	$575
9th - 10th	$900	$575

Your family's tuition worksheet:

Child	Grade Entering	Tuition
{student13}	{typeA55}	{student1tuition}
{student28}	{typeA56}	{student2tuition}
{student3}	{typeA57}	{student3tuition}
{student4}	{typeA58}	{student4tuition}

Your family's total tuition: ${totaltuition}

We are pleased to offer an additional $50 discount per family for tuition paid in full at time of registration!

Your family's total tuition if paid in full at time of registration: ${totaltuitionpaidinfull}

Student1Tuition
Student2Tuition
Student3Tuition
Student4Tuition
TotalTuition
TotalTuitionPaidInFull
I agree to pay tuition in full for my family in the amount of:
Please make a note of this amount! Your tuition total will NOT automatically carry over to the next page.
In addition, I agree to pay a tax-deductible donation to support CRC's education program in the amount of:
Please make a note of this amount! Your pledge amount will NOT automatically carry over to the next page.
OR.... I have spoken to Maxine Weil, Director of Congregational Learning, and agree to pay adjusted tuition in the amount of:
Please make a note of this amount! Your tuition total will NOT automatically carry over to the next page.
You will be directed to our website to make your tuition payment.

But first, please make a note of your tuition amount!
Your tuition total will NOT automatically carry over to the next page.

You must click on the SUBMIT button below
to complete your registration.
Should be Empty:

CRC Religious School Registration 2022-2023

Student Information

Parent Information

Social Media Permission

Student Medical Records 2020-2021

CRC Religious School Tuition Agreement