2023-2024 Amitim Registration - Form - Congregation Netivot Shalom

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Shalom,

We are thrilled that you are considering enrolling your child(ren) in Amitim! Our program is designed to prepare students for b'nei mitzvah and to teach synagogue skills and Jewish values, while building a sense of community among the cohort families.

Tuition includes:
* Tuesday Amitim classes for the 2023-2024 school year
* Family Education programs
* periodic additional programming for students
* One-on-one meetings and a rehearsal with the Rabbi to prepare for the service
* One-on-one meetings with the Rabbi to help students prepare a drash
* Snacks and periodic meals for the whole family
* Student's own Siddur (prayer book)
* mentoring and guidance in designing b'nei mitzvah tikkun olam projects

Please note that in addition to Amitim programs, most families will need an additional tutor to help with a student's specific Torah leyning and haftarah.

In order to celebrate a b'mitzvah at Congregation Netivot Shalom, one must be halachically Jewish, as defined by the Conservative Movement (meaning born to a Jewish mother or converted) and must be a current member of the congregation.

Amitim will meet on Tuesdays 4:00-6:00 (except for holidays), beginning with orientation on September 5, 2023 and concluding with a Siyum on May 21, 2024.

In addition to our Tuesday classes, Amitim students will join together for occasional Family Education programs, as well as a monthly Amitim Shabbat morning.

Thank you for filling this registration form in full and submitting a deposit.

If you have any questions, please contact Hillary Fox, Youth & Family Programming Coordinator, youth@netivotshalom.org

* Please select the number of children you are enrolling:

* Child 1 - First Name

* Child 1 - Last Name

Child 1 - Hebrew Name

Child 1 - Gender Pronouns

she/herhe/himthey/themask me in person

* Child 1 - Date of Birth

* Child 1 - After sunset?

Child 1 - Student Cell Phone Number (if applicable)

Child 1 - Student Email Address (if applicable)

* Child 1 - Entering Grade Fall 2023

* Child 1 - Name of School

Please let us know about any of Child 1's learning needs, accessibility needs, health needs, or allergies.

* Child 2 - First Name

* Child 2 - Last Name

Child 2 - Hebrew Name

Child 2 - Gender Pronouns

she/herhe/himthey/themask me in person

* Child 2 - Date of Birth

* Child 2 - After sunset?

Child 2 - Student Cell Phone Number (if applicable)

Child 2 - Student Email Address (if applicable)

* Child 2 - Entering Grade Fall 2023

* Child 2 - Name of School

Please let us know about any of Child 2's learning needs, accessibility needs, health needs, or allergies.

Emergency Contact Name and Number

Health Insurance Carrier

CHILD 1

CHILD 2

Health Insurance Member Number

Name of Primary Doctor

Doctor contact number

* First Name - Parent/Guardian #1

* Last Name - Parent/Guardian #1

Hebrew Name - Parent/Guardian #1

Work Phone - Parent/Guardian #1

Home Phone - Parent/Guardian #1

* Cell Phone - Parent/Guardian #1

* Email - Parent/Guardian #1

* Home Address - Parent/Guardian #1

* City - Parent/Guardian #1

* State - Parent/Guardian #1

* Zip - Parent/Guardian #1

First Name - Parent/Guardian #2

Last Name - Parent/Guardian #2

Hebrew Name - Parent/Guardian #2

Work Phone - Parent/Guardian #2

Home Phone - Parent/Guardian #2

Cell Phone - Parent/Guardian #2

Email - Parent/Guardian #2

Home Address IF DIFFERENT - Parent/Guardian #2

City - Parent/Guardian #2

State - Parent/Guardian #2

Zip - Parent/Guardian #2

Tuition: $1,800 for the 2023-2024 year.

Tuition payment must be complete by the time of your child's b'mitzvah ceremony.

A non-refundable deposit of $200 due with this registration and will go toward your tuition payment.

You have an option to set up a payment schedule. If you prefer to pay by check, mail it to the office.

Payment in full at registration qualifies for a $100 discount (total tuition after discount: $1,700).

My child/ren will attend OHDS in Fall 2023

* Please make your payment choice

Child 1 - Deposit of $200Child 1 - Pay Full tuition now $1,700 (Discount of $100)Child 2 - Deposit of $200Child 2 - Pay Full tuition now $1,700 (Discount of $100)A non-refundable deposit of $200 is due with registration.
Your deposit goes toward tuition.

SCHOLARSHIP DONATION

In addition to my child’s tuition, I would like to make a donation to support Jewish learning for youth at CNS. My payment will include an additional donation to the Youth Education Fund

Agreement for participation in Congregation Netivot Shalom's Amitim Religious School program:

Students are enrolled and contracted for the time period from September 5, 2023 through May 21, 2024. By completing this registration and making a deposit, I understand that my family is responsible for the entire tuition and that it will be paid in full before our child becomes Bar/Bat/B' Mitzvah.

Netivot Shalom reserves the right to void this contract at the discretion of the Rabbi in consultation with the Executive Director. In such instances, the unused portion of any prepaid fees may or may not be refunded.

By clicking the "I agree" button and putting your name in the signature box, you agree that you understand and accept the parameters for participating in Amitim and for celebrating a b'mitzvah with the congregation.

* By checking this box and putting my name in the signature box, "I agree" that I understand and accept the parameters for participating in Amitim and for celebrating a b'mitzvah with the congregation.

By checking this box and putting my name in the signature box, "I agree" that I understand and accept the parameters for participating in Amitim and for celebrating a b'mitzvah with the congregation.

* By checking this box I acknowledge that in order to celebrate a b'mitzvah at Congregation Netivot Shalom, one must be halachically Jewish, as defined by the Conservative Movement (meaning born to a Jewish mother or converted) and must be a current member of the congregation.

By checking this box I acknowledge that in order to celebrate a b'mitzvah at Congregation Netivot Shalom, one must be halachically Jewish, as defined by the Conservative Movement (meaning born to a Jewish mother or converted) and must be a current member of the congregation.

Check this box if you want a call to discuss membership, family circumstances, such as two-household parents, custody, or finances - with the Executive Director.Check this box if you want a call to discuss any accommodations we can make to the learning environment to help your child - with the Youth & Family Program Coordinator.Check this box if you would like to speak with the Rabbi about your child's halachic status as defined by the Conservative Movement.Check this box if you DO NOT grant permission to Netivot Shalom to use the registered child(ren)'s photograph/video in conjunction with marketing, publicity and advertising on behalf of Netivot Shalom. In addition, I will hold Netivot Shalom harmless for

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