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Berkman Family Center Enrollment Form
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Dear Families,
I am excited to welcome you to the Berkman Family Center at Rodef Shalom Congregation. Please complete the form below to begin the enrollment process. This form and payment of the deposit secures your child's enrollment for the Fall of 2024. Once we receive your enrollment, you will be sent the following documents:
1. Family Center Handbook
2. Child/Family Information Form
3. Child Health Appraisal Form
4. Tuition Agreement
5. ACH Debit Form
Please note that these documents and all deposits including enrollment and security must be completed no later than August 1, 2024.
As always if you have any questions, please reach out to me at feibus@rodefshalom.org
Best-
Ellie Feibus
Berkman Family Center Director
Student Information
*
Please select the class you are enrolling your child in:
Please Select One
Toddler (18-24 Months)
Young Twos (24-30 Months)
Older Twos and Young Threes (31-36 Months)
Preschool (3.5-5 Years)
*
Please select the number of days per week you wish your child to attend:
Please Select One
3 Days (Monday/Wednesday/Friday) $4520
5 Days $8020
*
Child's Name:
*
Child Age:
*
Gender:
Parent/Guardian 1
*
First Name:
*
Last Name:
*
Email:
*
Daytime Phone/Cell:
*
Street Address
*
Add a second parent/guardian?
Please Select One
No
Yes
Parent/Guardian 2
*
First Name:
*
Last Name:
*
Email:
*
Daytime Phone/Cell:
Street Address (if different from Parent/Guardian 1)
Vaccination Policy
The Berkman Family Center at Rodef Shalom Congregation requires all children to be vaccinated in accordance with the schedule recommended by the CDC's Advisory Committee on Immunization Practices or be on an alternate vaccination schedule approved by their pediatrician. Vaccine records, a copy of the alternate schedule, and a health appraisal provided and signed by the pediatrician are required for enrollment.
*
I have read and understand the Berkman Family Center Vaccination Policy.
I have read and understand the Berkman Family Center Vaccination Policy.
Membership
Rodef Shalom Congregation members recieve a 10% tuition discount.
*
Are you a Rodef Shalom Congregation Member?
Please Select One
Yes
No
Are you interested in receiving information about becoming a member of Rodef Shalom Congregation?
Yes
No
Tuition Deposit
To reserve a space, a non-refundable deposit of $150 must be paid no later than August 1, 2024. Deposits will be deducted from tuition. Payment can be made through this form or by check made payable to Rodef Shalom Congregation.
Pay $150 deposit now by credit card.
Pay $150 deposit now by credit card.
Pay $150 deposit by check.
Pay $150 deposit by check.
Please make checks out to Rodef Shalom Congregation
Pay by August 1, 2024
Security Fee
Your child's safety and the safety of our students, parents, and faculty is of the utmost importance. To maintain a high level of security all non-member families will be charged an additional security fee of $200 per family (not child) to reflect the security fee members pay as a part of their dues. Payment can be made through this form or by check made payable to Rodef Shalom Congregation.
Pay $200 security fee now by credit card.
Pay $200 security fee now by credit card.
Pay $200 security fee by check.
Pay $200 security fee by check.
Please make checks out to Rodef Shalom Congregation
Pay by August 1, 2024
Educator Appreciation Fund
The Berkman Family Center Parents Association (FCPA) prepares monthly educator appreciation gifts on behalf of the parent body. Although a donation is not mandatory, please consider contributing to the
Educator Appreciation Fund
.
Please select the amount you wish to contribute:
$18
$36
$54
$72
Payment can be made through this form or by check made payable to Rodef Shalom Congregation.
Make your FCPA contribution by check:
Make your FCPA contribution by check:
Please make checks out to Rodef Shalom Congregation
Pay by August 1, 2024
Questions, Comments, and Special Circumstances
If you have any questions, comments, or special circumstances please share them below.
Total Due Now:
Fri, May 3 2024
25 Nisan 5784
Tonight's Sefirah Count Is 11
היום אחד עשר יום שהם שבוע אחד וארבעה ימים לעמר
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