Gesher Registration 2024-2025 - Form - Congregation Shaarei Shamayim

Thank you for registering for Gesher!

There are three options for payment:

pay the entire year's tuition in advance
pay the first half of tuition by September 1 and the second half by January 12
pay in monthly installments

Please note: You are required to be a member of Congregation Shaarei Shamayim in order to enroll children in Gesher. Please join as a new member or renew your membership prior to registering for Gesher.

Questions? Please contact our office at office@shamayim.org or call 608-257-2944.

FAMILY INFORMATION

* New / Returning Family

* Parent/Guardian 1 First Name

* Parent/Guardian 1 Last Name

Home Phone

* Cell Phone

Work Phone

* Email

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Home Phone (if different)

Cell Phone

Work Phone

* Health Insurance Company

* Policy #

* Name and Phone Number of Student Primary Physician

* Emergency Contact Information

Please provide the name and number of a local friend or family member who can be contacted in case of an emergency (if parent/guardian is unreachable).

YOUR CHILD'S INFORMATION

* Student #1 First Name

* Student #1 Last Name

* Grade

* Date of Birth

MM/DD/YYYY

Pronouns (optional)

Allergies or medical conditions

To help us offer the best possible experience for your child, please provide any additional information about learning, social, emotional, or behavioral needs.

If no other children skip to the next section

Student #2 First Name

Student #2 Last Name

Grade

Date of Birth

MM/DD/YYYY

Pronouns (optional)

Allergies or medical conditions

To help us offer the best possible experience for your child, please provide any additional information about learning, social, emotional, or behavioral needs.

If no other children skip to the next section

Student #3 First Name

Student #3 Last name

Grade

Date of Birth

MM/DD/YYYY

Pronouns (optional)

Allergies and Medical Conditions

To help us offer the best possible experience for your child, please provide any additional information about learning, social, emotional, or behavioral needs.

Is there anything about your child(ren) you would like to share with Rabbi Laurie (e.g., divorce, custody arrangements, ongoing illness, recent death in the family)?

PARENTAL CONSENT

* Medical Emergency Release: I hereby give my permission to the physician or medical professional selected by staff to secure proper treatment for my child, which I understand might include hospitalization, injections, anesthesia, or surgery. I recognize that I will be responsible for any costs incurred for this treatment.

Please Select OneYesNo (If selected, you will be required to be on premise for all Gesher sessions and programs your child(ren) attends.)

* Transportation Release: By clicking 'Yes' below, I hereby permit my child to attend all Congregation Shaarei Shamayim Gesher school field trips. I understand that any volunteer driver who transports my child will a) have certified that s/he has auto insurance which will cover any injuries to CSS students in case of an accident; b) has a valid driver's license that is not suspended or revoked; c) does not have a health condition that may impair his or her ability to drive safely; d) will use an automobile in safe mechanical condition to drive CSS students; e) will promptly notify the Gesher Director if s/he is no longer able to certify any of the preceding four conditions.

Please Select OneYesNo (If selected, you will be responsible for transporting your child for all field trips and unable to ride share.)

If you are willing to drive students for occasional field trips, please check the below boxes:

I have auto insurance which will cover any injuries to Shaarei Shamayim Gesher students whom I am driving, should there be an accident.I have a valid driver's license which is not currently suspended or revoked.I do not have a health condition which will impair my ability to drive safely.I will use an automobile for driving Shaarei Shamayim Gesher students which is in safe mechanical condition.I will promptly notify the Gesher Director if I am no longer able to certify any of the above four items.

* Is this information correct to the best of your knowledge?

Please Select OneYesNo

Would you be interested in joining the Children's Education committee if a spot becomes available?

YesNoMaybe

Would you like to be a class parent? Duties include arranging snack, welcoming new parents to the community, and being a liaison to the teachers.

YesNoMaybe

Would you like to occasionally help plan holiday celebrations or do other discrete tasks?

YesNoMaybe

May we include your contact information in the Gesher roster?

YesNo

PAYMENT INFORMATION

Tuition

Kindergarten - 2nd grade: $425 (Sunday only)
3rd grade - 6th grade: $425 (Sunday only)
3rd grade - 6th grade: $650 (Sunday and tutoring)
7th grade: $425 (Sunday only)
7th grade: $650 (Sunday and tutoring)
Partial Year: $225 (pre-approval required)
Tutoring only: $500 (pre-approval required)

After September 1, a $25 late fee will be added onto to each enrollment (reflected in the total).

Multi-Child Discount
Families with more than one child can select a multi-child discount:

$100 for two children enrolled in the program
$200 for three or more children enrolled in the program

For scholarship information please contact the office at o ffice@shamayim.org. If requesting, select 'bill to account' when registering.

* Enter number of children at each rate

Kindergarten - 2nd Grade (Sunday only)

3rd - 6th Grade (Sunday only)

3rd - 6th Grade (Sunday and tutoring)

7th Grade (Sunday only)

7th Grade (Sunday and tutoring)

Tutoring Only (pre-approval required)

Multiple Child Discount: Select "1" for 2 children, or "2" for 3 or more children.

Total

After clicking 'Submit' below you will be directed to a payment confirmation page. There, you can enter your credit card or banking details and a payment schedule, or indicate that you will send a payment by check.