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MercazAliyahRegistration2023-2024
Please verify reCaptcha before submitting the form.
Welcome to Mercaz Aliyah Registration 2023 - 2024
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.
Sign up TODAY
Rates
Kindergarten/Grade 1 Non-Member $1,340
Kindergarten/Grade 1 Member $1,086
Additional K/1 Day $763
Gan Aliyah families are eligible for member rates!
Grades 2-5 $1,849
Grades 6-7 $1,885*
Monday Grades 6-7 Lounge $270
Transportation $505
*Includes $36 for USY membership
Financial assistance available
If you have any difficulties filling out this form, contact
Caroline
General Information
*
First Name Adult 1
*
Last Name Adult 1
*
Phone
*
Email
*
Address Parent 1 - Street
*
City/Town Parent 1
*
Zip Code Parent 1
First Name Adult 2
Last Name Adult 2
Cell Phone
Email
Address of Parent 2 (If Different from Parent 1)
City/Town (If Different from Parent 1)
Zip Code (If Different from Parent 2)
Parent Student(s) Reside With (if applicable)
*
Emergency Contact(s) (Other than parents)
Emergency Contact Phone #
Primary Contact for School Issues
Names & Phone Numbers of Adults who can pick up your child(ren)
Pediatrician Name and Phone #
Student Information
How many students are you registering?
Please Select
1 Member
1 NonMember
2 Member
2 NonMember
3 Member
3 NonMember
*
Student First Name
Student Nickname
*
Student Last Name
Student Preferred Pronouns
Student Email (Grades 6/7 ONLY)
This would be a personal email vs. an email issued by the school.
Student Phone # (Grade 6/7 ONLY)
Student Grade 2023-2024
Please Select 1
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
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
Email
Ellen
if you have questions about our schedule
Optional
Grades 6-7 Supervised Lounge/Homework Time Mondays 4:45-5:45pm, choose below
Non Member Student Grade 2023-2024
Please Select 1
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
Email
Ellen
if you have questions about our schedule
Additional Opportunities for Grades 6/7
For Students in Grades 6/7 Only
Grade 6/7 Monday Lounge $270
Grade 6/7 TACOS 2 No Fee
Monday Lounge
Monday lounge is a supervised space where students in grades 6 and 7 can do their homework or socialize. Pick-up time: 5:45.
TACOS2
Provides opportunities for socialization and learning through community service.
Name of School Student Attends?
What Time is Dismissal?
Any Behavior or Learning Issues You'd Like to Share With Us?
Upload IEP or 504 HERE - Thank you!
Does Student Take Medication?
No
Yes
List Medication(s) HERE
Does Student Have Food Allergies
No
Yes
List Allergies HERE
Can we give out a bandaid if needed?
Yes
No
Transportation
Transportation available from High Rock, Pollard, Elliot, Sunita Williams and Newman on
MONDAYS ONLY
Early Bird Fee $505.00 for the year
Are You Interested in Transportation?
No
Yes
In the event a transportation is not operating- Are you willing to drive students?
No
Yes
If you can drive students - How many?
If needed, do we have permission for your child to be driven by another parent?
No
Yes
Student 2
Student First Name
Student Nickname
Student Last Name
Student Preferred Pronouns
Student Email (Grade 6/7 ONLY)
Student's personal email, not one issued by the school
Student Phone # (Grade 6/7 ONLY)
Student 2 Grade 2023-2024
Please Select 1
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
Ellen
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
Non Member Student Grade 2023-2024
Please Select 1
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
Email
Ellen
if you have questions about our schedule
Additional Opportunities for Grades 6 and 7
For Students in Grade 6/7 ONLY
Grade 6/7 Monday Lounge $270
Grade 6/7 TACOS 2 No Fee
Monday Lounge
Monday lounge is a supervised space where students in grades 6 and 7 can do their homework or socialize. Pick-up time: 5:45.
TACOS2
P
rovides opportunities for socialization and learning through community service.
Name of School Student Attends
What Time is Dismissal?
Any Behavior or Learning Issues We Need to Know About?
Upload IEP or 504 Plan Here - Thank you!
Does Student Take Any Medication?
No
Yes
List Medication(s) HERE
Does Student Have Food Allergies?
No
Yes
List Allergies HERE
Can we give out a bandaid if needed?
Yes
No
Transportation
Transportation available from High Rock, Pollard, Elliot, Sunita Williams and Newman on
MONDAYS ONLY
Early Bird Fee $505.00 for the year
Are You Interested in Transportation?
No
Yes
In the event that transportation is not operating-Are you willing to drive students?
No
Yes
If you can drive students - How many?
If needed, do we have permission for your child to be driven by another parent?
No
Yes
Student 3
Student First Name
Student Nickname
Student Last Name
Student Preferred Pronouns
Student Email (Grade 6/7 ONLY)
This would be a personal email vs. an email issued by the school.
Student Phone # (Grade 6/7 ONLY)
Student Grade 2023-2024
Please Select 1
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
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
Email
Ellen
if you have questions about our schedule
Optional
Grades 6-7 Supervised Lounge/Homework Time Mondays 4:45-5:45pm, choose below
Non Member Student Grade 2023-2024
Please Select 1
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
Email
Ellen
if you have questions about our schedule
Additional Opportunities for Grades 6/7
For Students in Grades 6/7 Only
Grade 6/7 Monday Lounge $270
Grade 6/7 TACOS 2 No Fee
Monday Lounge
Monday lounge is a supervised space where students in grades 6 and 7 can do their homework or socialize. Pick-up time: 5:45.
TACOS2
P
rovides opportunities for socialization and learning through community service.
Name of School Student Attends
What Time is Dismissal?
Any Behavior or Learning Issues You'd Like to Share With Us?
Upload IEP or 504 HERE - Thank you!
Does Student Take Medication?
No
Yes
List Medications HERE
Does Student Have Food Allergies?
No
Yes
List Allergies HERE
Can we give out a bandaid if needed?
Yes
No
Transportation
Transportation available from High Rock, Pollard, Elliot, Sunita Williams and Newman on
MONDAYS ONLY
Early Bird Fee $505.00 for the year
Are You Interested in Transportation
No
Yes
In the event a transportation is not operating- Are you willing to drive students?
No
Yes
If you can drive students - How many?
If needed, do we have permission for your child to be driven by another parent?
No
Yes
Releases
Photo/Video Release
- I grant to Temple Aliyah, the right to take photographs of my child(ren) 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(ren) without his/her name and for any lawful purpose, including for example such purposes as publicity, illustration, advertising, and web content.
*
Sign Here for Photo Release
Write 'NO' if you don't want your child(ren)'s photo released
Youth Directory Release Form -
I grant permission for Temple Aliyah to include my child(ren) in the Temple Aliyah Youth Directory. The information in the Youth Directory includes parent's names, parent’s addresses, parent's phone numbers, parent’s emails, children's names, children's grades.
*
Sign HERE for Youth Directory
Write 'NO' if you don't want your information to be shared in the Youth Directory
Emergency Medical Treatment Authorization
- I hereby consent to the provision of emergency medical treatment for my child(ren) at any time that my child(ren) is/are attending Mercaz Aliyah or on any field trip with Mercaz Aliyah, and for my child(ren) 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(ren) is/are transported.
*
Sign HERE for Medical Authroization
Total
After you click 'Submit' you will be able to divide your tuition into payments or pay in full. If you wish to pay with a check, call the office and Caroline will take your registration over the phone and arrange for billing.
Tuesday, October 3 2023 18 Tishrei 5784