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Mercaz Aliyah Registration 2022-2023
Please verify reCaptcha before submitting the form.
Welcome to Mercaz Aliyah Registration 2022-2023
Before you get started, here are a few things to keep in mind.
LOG INTO YOUR SHULCLOUD ACCOUNT
You can register
ALL
of your children for Mercaz Aliyah on 1 form
If your form submission was successful, the website will let you know, you won't see a separate email.
Current Rates
Kindergarten/Grade 1 Non-Member $1,300
Kindergarten/Grade 1 Member $1,053
Additional K/1 Day $400
Gan Aliyah families are eligible for member rates!
Grades 2-5 $1,794
Grades 6-7 $1,830*
Monday Grades 6-7 Lounge $180
Transportation $500
*Includes $36 for USY membership
Financial assistance available
If you have any difficulties filling out this form, contact
Carolin
e@TempleAliyah.com
or
Kayla
@TempleAliyah.com
General Information
*
First Name Parent 1
*
Last Name Parent 1
*
Email Parent 1
*
Phone Number Parent 1
*
Address Parent 1 - Street
*
City/Town Parent 1
*
Zip Code Parent 1
First Name Parent 2
Last Name Parent 2
Email Parent 2
Phone Number Parent 2
Address Parent 2 (If Different from Parent 1)
City/Town Parent 2 (If Different from Parent 1)
Zip Code Parent 2 (If Different from Parent 1)
Parent Student(s) Reside With (if applicable)
*
Emergency Contact Name (other than parents)
*
Emergency Contact Phone #
*
Which Parent is the Primary Contact for School Issues
*
Pediatrition Name & Phone #
Student Information
How many students are you registering?
Please Select One
1 Member
1 NonMember
2 Member
2 NonMember
Student First Name
Student Nick Name
Student Last Name
Student's Preferred Pronouns
Student Email (Grades 6 and 7)
Student Phone # (Grades 6-7)
*
Student 1 Grade 2022-2023
Please Select One
Kindergarten Sundays
Kindergarten Sundays and Mondays
Grade 1 Sundays
Grade 1 Sundays and Mondays
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Kindergarten and 1st Grade Options
Sundays Only 9:30 - 11:45am
OR
Sundays and Mondays - for an additional fee
OR
Email
Kayla
for an alternate schedule
Grades 2-5 Schedule
Sundays 9:30 - 11:45am
AND
Mondays 3:45 - 5:45pm
Grades 6-7 Schedule
Sundays 9:30 - 11:45am
AND
Mondays 2:45 - 4:45pm
Optional
Grades 6-7 Supervised Lounge/Homework Time Mondays 4:45-5:45pm, choose below
*
Student 1 Grade 2022-2023 - Non Member
Please Select One
Kindergarten Sundays
Kindergarten Sundays and Mondays
Grade 1 Sundays
Grade 1 Sundays and Mondays
Kindergarten and 1st Grade Options
Sundays Only 9:30 - 11:45am
OR
Sundays and Mondays - for an additional fee
OR
Email
Kayla
for an alternate schedule
Additional Classes
Grade 6-7 Monday Lounge 4:45-5:45 - $180
Grade 7 TACOS 2 - No additional fee
Additional Hebrew tutoring available for an additional fee.
Contact
Kayla Reisman
if interested.
School Student Attends
Time School Dismisses
Transportation
No
Yes
Transportation available from High Rock, Pollard, Elliot, Sunita Williams and Newman on
MONDAYS ONLY
Fee $500.00 for the year
What is the student's favorite activity at school?
Are there any behavior issues we need to know about
Upload Student IEP or 504 Plan Here
Does Student Take Medication?
No
Yes
If Student Takes Medication, Please List Here
Does student have allergies?
No
Yes
If Student has allergies, please list here
Can we give student a bandaid if needed?
Yes
No
Can we dispense OTC medications like Tylenol, Acetaminophen, Benadryl
Tylenol
Ibuprofen
Benadryl
List Names and Phone Numbers of other adults who may pick up your student
Such as older siblings, grandparents, nanny or other relatives
Which camp does your student attend?
This could be a sleep away camp or day camp - it doesn't matter.
Photo/Video Release
- I grant to Temple Aliyah, the right to take photographs of my child in connection with experiences at Temple Aliyah. I authorize Temple Aliyah, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Temple Aliyah may use such photographs of my child without his/her name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content.
Sign here.
Youth Directory Release Form -
I grant permission for Temple Aliyah to include my child in the Temple Aliyah Youth Directory. The information in the Youth Directory is parent's names, parent’s addresses, parent's phone numbers, parent’s emails, children's names, children's grades and children's schools.
Sign here.
Emergency Medical Treatment Authorization
- I hereby consent to the provision of emergency medical treatment for my child at any time that my child is attending Mercaz Aliyah or on any field trip with Mercaz Aliyah, and for my child to be transported to a hospital if deemed advisable under the circumstances. In the event that I or another of the designated emergency contacts above cannot be contacted in a timely manner, I authorize the Education Director or his/her designee to give specific consent to any medical treatment and hospital care which is deemed advisable by and rendered under the supervision of any physician on the medical staff of any hospital to which my child is transported.
Sign here.
Consequences for Misbehavior
Student will be given 2 advanced verbal warnings or signal from classroom teacher before being referred to the Director of Congregational Learning's office.
Student referred to the Director of Congregational Learning's office for noncompliance will write apology to affected teacher/student(s), parents informed, and apology notice kept on file.
Student referred to Director of Congregational Learning's office for noncompliance more than once will have record of incident sent home to parents, with return signature required before they can return to class. Student will write apology to affected educator/student(s). Parents will be called immediately, and student may be required to leave for the day.
Open defiance such as fighting, weapons, drugs/alcohol, or any behavior that disrupts the class or prevents learning, will result in immediate referral to the administrative offices and could lead to immediate suspension and/or expulsion.
Sign here.
Student First Name
Student Nick Name
Student Last Name
Student's Preferred Pronouns
Student Email (Grades 6 and 7)
Student Phone # (Grades 6-7)
Student 2 Grade 2022-2023
Please Select One
Kindergarten Sundays
Kindergarten Sundays and Mondays
Grade 1 Sundays
Grade 1 Sundays and Mondays
Grade 2
Grade 3
Grade 4
Grade 5
Grade 6
Grade 7
Kindergarten and 1st Grade Options
Sundays Only 9:30 - 11:45am
OR
Sundays and Mondays - for an additional fee
OR
Email
Kayla
for an alternate schedule
Grades 2-5 Schedule
Sundays 9:30 - 11:30am
AND
Mondays 3:45-5:45pm
Optional
Grades 6-7 Supervised Lounge/Homework Time Mondays 4:45-5:45pm, choose below
Student 2 Grade 2022-2023 - Non Member
Please Select One
Kindergarten Sundays
Kindergarten Sundays and Mondays
Grade 1 Sundays
Grade 1 Sundays and Mondays
Kindergarten and 1st Grade Options
Sundays Only 9:30 - 11:45am
OR
Sundays and Mondays - for an additional fee
OR
Email
Kayla
for an alternate schedule
Additional Classes
Grade 6-7 Monday Lounge 4:45-5:45 - $180
Grade 7 TACOS 2 - No additional fee
Additional Hebrew tutoring available for an additional fee.
Contact
Kayla Reisman
if interested.
School Student Attends
Time School Dismisses
Transportation
No
Yes
Transportation available from High Rock, Pollard, Elliot, Sunita Williams and Newman on
MONDAYS ONLY
Fee $500.00 for the year
What is the student's favorite activity at school?
Are there any behavior issues we need to know about
Upload Student IEP or 504 Plan Here
Does Student Take Medication?
No
Yes
If Student Takes Medication, Please List Here
Does student have allergies?
No
Yes
If Student has allergies, please list here
Can we give student a bandaid if needed?
Yes
No
Can we dispense OTC medications like Tylenol, Acetaminophen, Benadryl
Tylenol
Ibuprofen
Benadryl
List Names and Phone Numbers of other adults who may pick up your student
Such as older siblings, grandparents, nanny or other relatives
Which camp does your student attend?
This could be a sleep away camp or day camp - it doesn't matter.
Photo/Video Release
- I grant to Temple Aliyah, the right to take photographs of my child in connection with experiences at Temple Aliyah. I authorize Temple Aliyah, its assigns and transferees to copyright, use and publish the same in print and/or electronically. I agree that Temple Aliyah may use such photographs of my child without his/her name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content.
Sign here.
Youth Directory Release Form -
I grant permission for Temple Aliyah to include my child in the Temple Aliyah Youth Directory. The information in the Youth Directory is parent's names, parent’s addresses, parent's phone numbers, parent’s emails, children's names, children's grades and children's schools.
Sign here.
Emergency Medical Treatment Authorization
- I hereby consent to the provision of emergency medical treatment for my child at any time that my child is attending Mercaz Aliyah or on any field trip with Mercaz Aliyah, and for my child to be transported to a hospital if deemed advisable under the circumstances. In the event that I or another of the designated emergency contacts above cannot be contacted in a timely manner, I authorize the Education Director or his/her designee to give specific consent to any medical treatment and hospital care which is deemed advisable by and rendered under the supervision of any physician on the medical staff of any hospital to which my child is transported.
Sign here.
Consequences for Misbehavior
Student will be given 2 advanced verbal warnings or signal from classroom teacher before being referred to the Director of Congregational Learning's office.
Student referred to the Director of Congregational Learning's office for noncompliance will write apology to affected teacher/student(s), parents informed, and apology notice kept on file.
Student referred to Director of Congregational Learning's office for noncompliance more than once will have record of incident sent home to parents, with return signature required before they can return to class. Student will write apology to affected educator/student(s). Parents will be called immediately, and student may be required to leave for the day.
Open defiance such as fighting, weapons, drugs/alcohol, or any behavior that disrupts the class or prevents learning, will result in immediate referral to the administrative offices and could lead to immediate suspension and/or expulsion.
Sign here.
Total
After you click
Submit,
you will be able to divide your tuition into payments or pay in full.
Monday, December 11 2023 28 Kislev 5784