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Machon Micah K-7th Registration Form 5775 (2014-2015)

by David Diskin last modified 08-08-2014 12:50 PM

Registration is now open for Machon Micah for 2014-2015. Families enrolling a child for the first time in Machon Micah need to attend a new parent orientation meeting with our Director of Congregational Learning, Rabbi Josh Beraha, before completing a registration form.  Rabbi Beraha can be reached at jberaha@templemicah.org.

Temple Micah membership is required for enrollment in Machon Micah. Current members must have all balances paid in full, one third of 2014-2015 dues paid, and 2014-2015 Machon Micah tuition paid in full or a credit card submitted. If you have questions about membership or need to make alternative financial arrangements, please contact our executive director, Rachel Gross, at 202-342-9175.

If paying in full by check, the fees are:
  • $690 for K-2nd grade
  • $710 for 3rd grade
  • $770 for 4th grade
  • $1115 for 5th-7th grades
If paying by credit card in six equal installments, the fees are:
  • $710 for K-2nd grade
  • $730 for 3rd grade
  • $790 for 4th grade
  • $1150 for 5th-7th grades

Registration

We have three registration deadlines, which are detailed below. We ask that you please register as early as possible, as it makes our planning so much easier.

"Fully completed registration" means that

A. Paperwork has been submitted in the online form below AND

B. Payment has been been arranged in one of the following three ways:

  1. A check for full payment has been received by the office before the registration date. (Checks "in the mail" by the registration date don't count!)
  2. Credit card information has been submitted via the registration form OR by phone to Joy Ash (202-342-9175).  Credit card payments will take place in six installments, from September through February.

The three registration deadlines are: .

  • Families who have fully completed registration by July 15th will be given early access to the Skype tutoring sign-up sheet on Thursday, July 31st.
  • Families who have fully completed registration by August 1st will receive access to the Skype tutoring sign-up sheet on Thursday, August 14th.
  • Families who have fully completed registration by August 15th will receive access to the Skype tutoring sign-up sheet on Thursday, August 28th. Registration is due by September 2nd at the latest.
Parent/Guardian #1
(Required)
first name, last name
(Required)
(Required)
(Required)



(Required)
(Required)
(Required)
(Required)
(Required)
optional
Parent/Guardian #2
first name, last name
if not, please fill out information below



if different from parent/guardian #1
optional
Emergency Contacts
other than parents/guardians
(Required)
(Required)
(Required)
(Required)
(Required)
(Required)
(Required)
(Required)
Child #1
(Required)
First and last name (ex. Vanessa Harper)
(Required)


(Required)
indicate parent/guardian with whom the child lives.


This can be either the child's address or a parent's address at which the child can be reached for Skype tutoring (3rd to 7th grades only)
Optional
(Required)
If different from grade at Temple Micah
Please list general health condition, including any vision, speech, or hearing issues, any specific physical condition or illness - past or present
This information will be provided to all teachers on staff, and will also be posted in the kitchen. We do not want to treat this information confidentially because we want it to be as widely available as possible.
if any, provide name and purpose of each medication
Please also feel free to contact Rabbi Beraha directly.
Child #2
First and last name (ex. Vanessa Harper)


indicate parent/guardian with whom the child lives.


This can either be the child's address or a parent's address at which the child can be reached for Skype tutoring (3rd-7th grades only)
Optional
If different from grade at Temple Micah
Please list general health condition, including any vision, speech, or hearing issues, any specific physical condition or illness - past or present
This information will be provided to all teachers on staff, and will also be posted in the kitchen. We do not want to treat this information confidentially because we want it to be as widely available as possible.
if any, provide name and purpose of each medication
Please also feel free to contact Rabbi Beraha directly.
Child #3
First and last name (ex. Vanessa Harper)


indicate parent/guardian with whom the child lives.


This can either be the child's address or a parent's address at which the child can be reached for Skype tutoring (3rd-7th grades only)
Optional
If different from grade at Temple Micah
Please list general health condition, including any vision, speech, or hearing issues, any specific physical condition or illness - past or present
This information will be provided to all teachers on staff, and will also be posted in the kitchen. We do not want to treat this information confidentially because we want it to be as widely available as possible.
if any, provide name and purpose of each medication
Please also feel free to contact Rabbi Beraha directly.
Health Care Information
Liablilty Release Agreement
I, the undersigned, request permission for the above students to participate in the various activities of Machon Micah. I understand the student(s) may take part in Machon Micah activities occurring on its premises, as well as, outside its premises. I know the risks and hazards involved in the said activities, and that anticipated and unexpected injuries may arise during such activities. I assume all risks of injury to the student(s) person and property that may be sustained in connection with these activities. I understand that it is not the function of the Machon Micah, its agents, servants, employees, instructors and officers to guarantee the safety of the participant with respect to these activities. I also understand that the student(s) has the responsibility to exercise due care for all participants safety in the performance of these activities. In consideration of the student(s) being permitted to enroll and participate in these activities, I do hereby release, discharge, indemnify, and hold harmless Machon Micah, its agents, servants, employees, instructors, and officers, and all other participants in the stated activities, of and from all claims, demands, actions, and causes of action of any sort for injuries sustained by the student(s) as a result of or relating to these activities.
(Required)

(Required)
/ /
(Required)
first name, last name
Photo Release Agreement
Temple Micah occasionally photographs its members, including children, engaged in Micah-related activities. Unless you withhold your permission by indicating below, you consent to Temple Micah using such photographs for appropriate Temple Micah purposes, including Temple Micah's website, newletter and facebook page.
(Required)


(Required)
/ /
(Required)
first name, last name
Carpool/Bus Release Agreement
I hereby acknowledge that my child(ren) may ride on any bus or in any carpool arranged by Temple Micah. If and when the behavior of my child(ren) becomes too distracting for the others on or the driver of the van, I acknowledge that she or he will be asked to find other transportation. In consideration of the opportunity for my child to participate and fully recognizing that such as undertaking involves an element of risk, we assume all risks and hazards incidental to such participation and do hereby release, absolve, indemnify, and agree to hold harmless Temple Micah, nor any of said persons shall be held financial responsible for any injury, illness or death as a direct or indirect result of this activity.
(Required)


(Required)
/ /
(Required)
first name, last name
Payment Options
Please choose how you would like to pay
(Required)



enter as visa: 1234567890123456
mm/yyyy


 

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