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Shorashim Registration 2022-2023

We are looking forward to the 2022-2023 school year! In order to help us plan most effectively, please register as soon as possible. We are excited for a year of growth, laughter and learning!

Gesher and Limmud registration coming soon!

2022-2023 SHORASHIM PROGRAM RATES

Early Bird (listed below) extended to Wednesday, June 1.

Refer a Friend Program – for each family you refer to Shorashim who signs up, you will receive $100 off of your tuition.
Non members whose child/children are attending their first year of Shorashim are eligible for a free year of TIC membership (July 1, 2022-June 30, 2023).

Registration:

Payment in full is due at the time of registration. However, if you would like to make alternative payment arrangements, please fill out the form below in full and then choose “I would like to discuss a payment arrangement.” Note: You must hit the submit button or your request will not go through.
A learner may not begin the school year unless Temple Israel Center has either received payment in full or payment arrangements have been made.

Credit Card Payment

All payments made by credit card will incur a 3% processing fee.

Absences or Voluntary Withdrawal

In the case of absences, school closings, or voluntary withdrawal, all tuition is non-refundable and make-ups or adjustments will not be made. In the event of a special or unforeseen circumstance, please be in touch with Director of Learning and Inclusion Michelle Steinhart.

Shorashim Registration Form 2022-2023

"*" indicates required fields

Are you a Temple Israel Center member family?*

Yes

No

Is this your first year at Shorashim?*

Yes

No

Non members whose child/children are attending their first year of Shorashim are eligible for a free year of TIC membership (September 1, 2022-June 30, 2023). Are you interested in a free TIC membership?

No thank you.

Yes. Please contact me.

If you were referred by a friend, please let us know their name.

Adult #1 Information

Name*

First Last

Address*

Street Address City State ZIP Code

Primary Phone*

Secondary Phone

Email*

May we use the above email address for correspondence?*

Yes

No

Adult #2 Information

Name

First Last

Is the address the same as above?

Yes

No

Address

Street Address City State ZIP Code

Primary Phone

Secondary Phone

Email

May we use the above email address for correspondence?

Yes

No

Emergency Contact Information

Contact #1 Name*

First Last

Contact #1 Relationship*

Contact #1 Primary Phone*

Contact #1 Secondary Phone

Contact #2 Name*

First Last

Contact #2 Relationship*

Contact #2 Primary Phone*

Contact #2 Secondary Phone

Media Release

I consent to the use of my child(ren)'s photograph or likeness in photo, video, or printed marketing and/or promotional materials (names will not be included) for Shorashim or Temple Israel Center.

Consent Checkbox (Hidden label)*

I consent

Child's Name*

First Last

Child's Hebrew Name

Child's Pronoun*

e.g. he, she, they. TIC is respectful of each learner's gender identity.

Additional Information

Please share any information (including allergies/food restrictions, medications, learning and/or social emotional needs, etc.) that will enable us to create a successful learning experience for your child.

Child's Date of Birth*

Child's School for 2022-23*

Child's Grade for 2022-23 School Year*

Meets Sundays, 9:00-11:30 am.

Meets Sundays from 9:00-11:30 am, and one weekday afternoon from 4:00-5:30pm (select preference of Wednesday or Thursday below). Ultimately, the schedule of class offerings will be based on sufficient minimum enrollment.

Please choose a session:

Wednesdays, 4:00-5:30 pm

Thursdays, 4:00-5:30 pm

Tuition for Pre-K (3-4 year olds)/Kindergarten/1st Grade for Child

Price:

Tuition for 2nd-6th Grade

Price:

Tuition for Pre-K (3-4 year olds)/Kindergarten/1st Grade

Price:

Tuition for 2nd-6th Grade

Price:

PTO dues

Price:

Security Assessment

Price:

Would you like to register a 2nd Child?

Yes

No

Child 2's Name

First Last

Child 2's Hebrew Name

Child 2's Pronoun

e.g. he, she, they. TIC is respectful of each learner's gender identity.

Child 2's Additional Information

Please share any information (including allergies/food restrictions, medications, learning and/or social emotional needs, etc.) that will enable us to create a successful learning experience for your child.

Child 2's Date of Birth

Child 2's School for 2022-23

Child 2's Grade for 2022-23 School Year

Meets Sundays, 9:00-11:30 am.

Meets Sundays from 9:00-11:30 am, and one weekday afternoon from 4:00-5:30pm (select preference of Wednesday or Thursday below). Ultimately, the schedule of class offerings will be based on sufficient minimum enrollment.

Please choose a session:

Wednesdays, 4:00-5:30 pm

Thursdays, 4:00-5:30 pm

Tuition for Pre-K (3-4 year olds)/Kindergarten/1st Grade for Child 2.

Price:

Tuition for 2nd-6th Grade for Child 2.

Price:

Tuition for Pre-K (3-4 year olds)/Kindergarten/1st Grade for Child 2.

Price:

Tuition for 2nd-6th Grade for Child 2.

Price:

PTO dues for Child 2

Price:

Would you like to register a 3rd Child?

Yes

No

Child 3's Name

First Last

Child 3's Hebrew Name

Child 3's Pronoun

e.g. he, she, they. TIC is respectful of each learner's gender identity.

Child 3's Additional Information

Please share any information (including allergies/food restrictions, medications, learning and/or social emotional needs, etc.) that will enable us to create a successful learning experience for your child.

Child 3's Date of Birth

Child 3's School for 2022-23

Child 3's Grade for 2022-23 School Year

Meets Sundays, 9:00-11:30 am.

Meets Sundays from 9:00-11:30 am, and one weekday afternoon from 4:00-5:30pm (select preference of Wednesday or Thursday below). Ultimately, the schedule of class offerings will be based on sufficient minimum enrollment.

Please choose a session:

Wednesdays, 4:00-5:30 pm

Thursdays, 4:00-5:30 pm

Tuition for Pre-K (3-4 year olds)/Kindergarten/1st Grade for Child 3.

Price:

Tuition for 2nd-6th Grade for Child 3.

Price:

Tuition for Pre-K (3-4 year olds)/Kindergarten/1st Grade for Child 3.

Price:

Tuition for 2nd-6th Grade for Child 3.

Price:

PTO dues for Child 3

Price:

Would you like to register a 4th Child?

Yes

No

Child 4's Name

First Last

Child 4's Hebrew Name

Child 4's Pronoun

e.g. he, she, they. TIC is respectful of each learner's gender identity.

Child 4's Additional Information

Please share any information (including allergies/food restrictions, medications, learning and/or social emotional needs, etc.) that will enable us to create a successful learning experience for your child.

Child 4's Date of Birth

Child 4's School for 2022-23

Child 4's Grade for 2022-23 School Year

Meets Sundays, 9:00-11:30 am.

Meets Sundays from 9:00-11:30 am, and one weekday afternoon from 4:00-5:30pm (select preference of Wednesday or Thursday below). Ultimately, the schedule of class offerings will be based on sufficient minimum enrollment.

Please choose a session:

Wednesdays, 4:00-5:30 pm

Thursdays, 4:00-5:30 pm

Tuition for Pre-K (3-4 year olds)/Kindergarten/1st Grade for Child 4.

Price:

Tuition for 2nd-6th Grade for Child 4.

Price:

Tuition for Pre-K (3-4 year olds)/Kindergarten/1st Grade for Child 4.

Price:

Tuition for 2nd-6th Grade for Child 4.

Price:

PTO dues for Child 4

Price:

Payment

Payment Method*

E-check

Credit card — payment includes an additional 3% of the total to help defray credit card processing fees.

I want to use a different form of payment. Please have the financial department contact me. (NOTE: Please click the "Submit" button below.)

I would like to discuss a payment arrangement. Please have the financial department contact me. (NOTE: Please click the "Submit" button below.)

Additional 3% payment for credit card processing fees

Price: $0.00

Total

ACH / E-check

Account Number Account Type Routing Number Account Holder Name

Credit Card

Discover

MasterCard

Visa

Supported Credit Cards: Discover, MasterCard, Visa

Card Number

Expiration Date Month Year

Security Code Cardholder Name

CAPTCHA

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