Student Application 2015-2016 School Year

B"H

TCA Elementary and Middle School Application

2019-2020 School Year

Application process for Elementary and Middle School

Thank you for your interest in Tenafly Chabad Academy. In order to be considered for acceptance, please complete the steps below.

1. Complete the Application form below.

2. Provide previous school records including: most recent report cards, teachers recommendations, copies of evaluations (if applicable).

3. Attend a personal interview with the school principal.

4. Attend a personal interview and assessment with members of the admissions team.

5. Upon acceptance, families will be required to pay a non-refundable registration fee of $990

CHILD'S INFORMATION

Last name *

First name *

Hebrew name

Date of Birth *

Date

Hebrew Date of Birth

Place of Birth *

Languages Spoken at Home (other than English)

Recent Photo (jpg, jpeg, png) *

Browse Files

Mother's Cell Phone Number *

Father's Cell Phone Number *

Preferred Phone For School Communication *

Mother's Father's Both

Mother's E-mail *

Father;s E-mail

Preferred E-mail For School Communication *

Mother's Father's Both

Street address *

City *

State *

Zip code *

Child"s Gender *

Female Male

Applying for Grade *

1 Grade 8:15-3:00 2 Grade 8:15-3:00 3 Grade 8:15-3:00 4 Grade 8:15-3:00 5 Grade 8:15-4:15 6 Grade 8:15-4:15 7 Grade 8:15-4:15 8 Grade 8:15-4:15

TUITION RATES:

1st Grade	8:15-3:00	$13,900
2nd – 4th Grades	8:15-3:00	$14,700
5th - 6th Grade	8:15-4:15	$15,770
7th – 8th Grade	8:15-4:15	$16,770

FRIDAY DISMISSAL AT 1:00 PM FOR ALL

Registration Fee ‐ $990 per application - payable upon acceptance to TCA.
Security Fee ‐ $400 per child
Annual Family Obligation ‐ $770, For full paying families with a child in grade 1 and above,
this includes 2 non‐transferable annual dinner reservations.
Sibling Discount ‐ $360 offer off one child
Twin Discount ‐ $500 offer off one child
NO Building Fund

Please list all current and previous schools and/or camps your child has attended. Please provide principal's name and phone number *

Does your child have an IEP? *

Yes No

Has your child received any type of intervention, occupational/speech/early intervention therapy, or long term medical treatment? *

Yes No

Please specify names, dates, and reasons and e-mail reports to tca@lpsnj.org

FAMILY INFORMATION

Are both biological parents living? *

Yes No

Parents Are

If parents are divorced, to whom should admissions correspondence be sent?

If parents are remarried, please indicate the name of the step-parent:

FATHER/GUARDIAN INFORMATION

Title *

Father's Name *

Father's Last Name *

Father's Cell Phone

Father's Work Phone

Father's E-mail

Occupation

Employer

MOTHER/GUARDIAN INFORMATION

Title *

Mother's Name *

Mother's Last Name *

Mother's Cell Phone *

Mother's Work Phone *

Mother's E-mail

Occupation

Employer

Is the Child's Biological Mother Jewish? *

Yes No

Has the child or child’s mother had a conversion? If yes, please provide the conversion certificate.

Yes No

SYNAGOGUE AFFILIATION

Name of the Synagogue, City and State

Name of the Rabbi

PARENT/GUARDIAN RECOMMENDATIONS

If your child has any special considerations, including health issues or special needs which you feel Tenafly Chabad Academy should be aware of, please describe briefly:

How did you hear about Tenafly Chabad Academy?

Please specify friend or family associate

Why do you feel Tenafly Chabad Academy is the appropriate school for your child?

Emergency Contact (in case any of the parents can't be reached)

In the event of an emergency, please contact:

Emergency Contact Name *

Relationship

Emergency Contact Phone Number *

Is this person authorized to pick up your child? *

Yes No

People authorized to pick up your child from school (other than carpool or parents)

Child Release 1: First and Last Name *

Relationship *

Child Release 2: First and Last Name

Relationship

Field Trip Permission

I give permission for my child to participate in walking trips within the school’s neighborhood. *

Yes No

Photo Permission I hereby grant permission for photography and videography of my child’s activities at the school or any activities related to the school for public relations purposes (social media). I agree that I am to receive no compensation for my child’s appearance and that this participation confers on me no ownership rights whatsoever. (Please mark yes or no)

Photo Release *

Yes No

MEDICAL INFORMATION

Please list any of the following: Current medications, medication allergies, food allergies, or chronic health concerns. If none, please write N/A. (More detailed medical forms will be sent out later and due back in the Spring) *

By submitting this form, I attest that the above information is correct. I consent to have to the school administration contact my child"s previous schools and any professionals that worked with my child and I am aware that class placement is at the discretion of the school Principal. Please include submit the following documents for all transfer students: Report cards Evaluations (if applicable) Copy of birth certificate or birth record

APPLICATION/REGISTRATION FEE

$990 per child

The application fee is non-refundable and does not get applied towards the cost of tuition.

Upon clicking "Submit" you will be redirected to the secured payment processing website. If paying by credit card please submit your credit card information on the next page. If paying by check, please mail your payment made to Lubavitch on the Palisades to 11 Harold St, Tenafly NJ 07670. Please be advised that without payment your application will remain on hold.