Student’s Last Name:                                                                  First Name:                                                 

Student’s Birth Date:                         Grade (11-12 School Year):                   Temple Affiliation:

Student’s Address, City Zip:

Student Resides with:                                                          Home Phone:

Mother’s Name:Mother's Cell:

Father’s Name:                                                                     Father's Cell:

Parent E-mail:                                                        Student E-mail:





PICK-UP AUTHORIZATION
Besides parent(s)/guardian(s), who else is authorized to pick up your child from school?
Who is not permitted to pick up your child from school?( write n/a if applicable)

EMERGENCY CONTACT:

Name, Phone:

Medical Insurance Co., Phone:

Policy #:

Does your child have any allergies? (explain or n/a if applicable)




Please explain any important information about your child:











PAYMENT/REFUND POLICY:
Payment is due at the time of registration- unless prior arrangements are made with the Director.
Judaica High School tuition is separate from any additional fees due for individual synagogue school and/or programming.
Refund requests must be made in writing:
       Prior to the beginning of class, fees will be returned except for a $75 processing fee.
       75% will be returned before September 30, 2012.
       No refunds will be provided after September 30, 2012.


Overall, I submit registration for my child for Judaica High School of Broward County 2011-2012 School Year. I understand that session and class placement is left up to the discretion of the Director. I accept the rules and regulations adopted by Judaica High School as outlined in the Parent Handbook at www.cajebroward.org. The student’s disregard of the rules and regulations of the school may be deemed sufficient cause for dismissal.

I acknowledge Judaica High School has permission to photograph and video my child for marketing and promotional purposes.
I acknowledge that I have read both sides of this application and agree to all terms contained herein.

Broward County Community Judaica High School
2012-2013 Registration Form
                                                                         

2011-2012
TUITION AND FEE SCHEDULE

FEES* (Include tuition, programs, materials, & security)
                                                                 
7th Grade8th-12th Grade11th-12th Grade
       Non-Dual Enrollment         Dual Enrollment Only
Pre-Registration Special
                        By May 15th                      $465             $510                       $555

Early Bird Discount
May 16th- June 15th                   $495             $555                      $600

Register  After June 15th                                  $555             $600                      $655

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Additional Fees

Security Fee (All Students)                                $25                        $25                               $25


TBO Members only:
     Confirmation Fee                                 N/A           $30-8th & 9th                      N/A
                                                                                                      $200- 10th

Unaffiliated                                                 $100            $100                        $100
 

  *To receive early discount rates, payments must be paid by the registration dates listed.
  Limited partial scholarships available. Applications due by August 15, 2012.   

COURSE SELECTIONS AND CALENDARS WILL BE MAILED SEPARATELY..
Make checks payable and mail to:
Orloff Central Agency for Jewish Education
5890 South Pine Island Road, Davie, Florida 33328

****TBO Members: Mail make out and mail checks to:
Temple Beth Orr
2151 Riverside Drive, Coral Springs, Florida  33071


DATE RECEIVED:

________________________

Student Request Provision: I request that my child be with:                                                                                One mutual  
  request only. Multiple requests will void your request option. No requests will be considered once classes are formed.

I wish to donate the following amount to the Judaica High School Scholarship Fund to help provide a Jewish Education for a Jewish child of a less fortunate family.
_____ $180    _____ $360  _____ $500  _____ $720  _____ $1,000
I agreeI do not agree
I have read the payment/refund policy.
I have read and agree to the policies above.
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