2020-21 ALMA Registration - Form - Congregation B'nai Israel (Northampton)

Join ALMA 2020-21!

Learn more about our ALMA program on our website and register for this year's program below. We look forward to this year of Jewish Education with you and your young people!

This year, our distance learning community centers Judaism in your home, guided by our educators and specialists.

Our ALMA program starts September 8 and concludes May 22.

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* Is your family new to our school this year?

Please Select OneYesNo

Section A: Family or Caregiver Contact Information

* First Name (Primary)

* Last Name (Primary)

* Email (Primary)

* Phone (Primary)

* Relationship to Student(s) (Primary)

* Street Address (Primary)

Street Address Line 2 (Primary)

* City (Primary)

* State (Primary)

* ZIP (Primary)

* Is there a secondary contact?

Please Select OneNoYes, at the same address as the primary contactYes, but at a different address than the primary contactIf there is a secondary contact, all emails and mailings will go to both contacts. In case of urgent need, the primary contact will be notified first

* First Name (Secondary)

* Last Name (Secondary)

* Email (Secondary)

* Phone (Secondary)

* Relationship to Student(s) (Secondary)

* Street Address (Secondary)

Street Address Line 2 (Secondary)

* City (Secondary)

* State (Secondary)

* ZIP (Secondary)

* Emergency Contact Name

* Emergency Contact Best Phone

* Emergency Contact Relationship

Family Physician Name

Family Physician Phone Number

Insurance Group or ID#

Medical Insurance Provider

Section B: Student Enrollment Information

ALMA Tuition makes it possible for our program to sustain educators, specialists, meet our overhead needs and provide materials for students. ALMA tuition fees can be paid one time annually or monthly through a payment plan. Financial aid is available to CBI members. Monthly payments will begin with a first payment when you submit this form. The next payment will be on September 15 and on the 15th of the month until May 15, 2020 (10 months total).

ALMA Tuition Rates

Ages 3-5, Pre-K

Total annual tuition: $600

Monthly payment: $60/month, 10 months

Kindergarten-1st Grade

Annual tuition: $850

Monthly Payment: $85/month, 10 months

Grades 2nd-8th

Annual tuition: $1425

Monthly payment: $142.50/month, 10 months

Student 1 Information

* Student 1 First Name

* Student 1 Last Name

* Student 1 Birthdate

* Student 1 Hebrew Name

What pronouns does your child use?

Student 1's Grade as of Fall 2020

* Student 1 Preferred Name

Student 1 Email (if applicable)

Information will not be shared publicly. Parents will be copied on all communication to students.

Student 1 Phone (if applicable)

Information will not be shared publicly. Students will not be contacted independently from parents.

* Student 1 Allergies or Medications

Please Select OneNoYesDoes your child have allergies or medications we need to know about?

Student 1 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

* Student 1 Learning Needs: What supports your child to learn better in a traditional classroom?

Student 1 Learning Needs: What supports your child to learn well in a distance learning classroom?

* Student 1: Does your child have a formal IEP or 504 plan?

Please Select OnePlease select oneYesNo

If applicable, upload your student's IEP file here

If you have access to your student's IEP, please upload here for their teacher to review

* Student 1: Select Tuition

Student 2 Information

* Student 2 First Name

* Student 2 Last Name

* Student 2 Birthdate

* Student 2 Hebrew Name

What pronouns does your child use?

Student 2's Grade as of Fall 2020

* Student 2 Preferred Name

Student 2 Email (if applicable)

Information will not be shared publicly. Parents will be copied on all communication to students.

Student 2 Phone (if applicable)

Information will not be shared publicly. Students will not be contacted independently from parents.

* Student 2 Allergies or Medications

Please Select OneNoYesDoes your child have allergies or medications we need to know about?

Student 2 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

* Student 2 Learning Needs: What supports your child to learn better in a traditional classroom?

Student 2 Learning Needs: What supports your child to learn better in a distance learning classroom?

Does your student have a formal IEP or 504 plan?

Please select oneYesNo

Student 2: If applicable and accessible, upload your student's IEP file

* Student 2: Select Tuition

Student 3 Information

* Student 3 First Name

* Student 3 Last Name

* Student 3 Birthdate

* Student 3 Hebrew Name

What pronouns does your child use?

Student 3's Grade as of Fall 2020

* Student 3 Preferred Name

Student 3 Email (if applicable)

Information will not be shared publicly. Parents will be copied on all communication to students.

Student 3 Phone (if applicable)

Information will not be shared publicly. Students will not be contacted independently from parents.

* Student 3 Allergies or Medications

Please Select OneNoYesDoes your child have allergies or medications we need to know about?

Student 3 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

* Student 3 Learning Needs: What supports your child to learn better in a traditional classroom?

Student3: What supports your child to learn better in a distance learning classroom?

Student3: Does your child have a formal IEP or 504 plan?

Please select oneYesNo

If applicable and accessible, upload your student's IEP file here

If accessible to you, please upload your student's IEP for their teacher to review

* Student 3: Select Tuition

Student 4 Information

* Student 4 First Name

* Student 4 Last Name

* Student 4 Birthdate

* Student 4 Hebrew Name

What pronouns does your child use?

Student 4's grade as of Fall 2020

* Student Preferred Name

Student 4 Email (if applicable)

Information will not be shared publicly. Parents will be copied on all communication to students.

Student 4 Phone (if applicable)

Information will not be shared publicly. Students will not be contacted independently from parents.

* Student 4 Allergies or Medications

Please Select OneNoYesDoes your child have allergies or medications we need to know about?

Student 4 Allergy/Medication Details

Please describe allergies and medications with dosage and timing.

* Student 4 Learning Needs: What supports your child to learn better in a traditional classroom?

Student 4: What supports your child to learn better in a distance learning classroom?

Student 4: Does your student have a formal IEP or 504 plan?

Please select oneYesNo

If applicable and accessible, upload your student's IEP here

If you have access to your student's IEP, please upload here for their teacher to review.

* Student 4: Select Tuition

Section C: Release Forms

* Safety Waiver: My (our) understanding is that this program is based in-home. I assume responsibility for my child(ren) during all ALMA I agree to supervise any online accounts that my child(ren) may access and participate in. I will ensure that my child(ren) is dressed and behaves appropriately.

By typing my name, I have read and understand the above statement.

* Memorandum of Understanding: ALMA Staff will review appropriate behaviors and expectations with students. If staff notice something on my child(ren)’s video that they determine is not appropriate, they may turn off my child(ren)’s video until the issue is resolved. Bullying, including cyberbullying, during a session or outside of a session will not be tolerated. Issues and consequences will be addressed with the student and a parent.

By typing my name, I have read and understand the above statement.

* Media Release: From time to time your child's photo may be taken in our classrooms or at special events. We use these photos in our newsletters, on our website, in our Facebook posts and other publicity materials.

Please Select OneI grant permission for my child(ren)'s image to be used in all mediaI grant permission for my child(ren)'s image to be used only in internal synagogue mediaI do not grant permission for my child(ren)’s image to be used

Section D: ALMA Family Programs & Support

Our ALMA family programs build relationships and infuse joy into our Jewish lives. They cannot happen, however, without the support of our ALMA parents. This year, we have the unique opportunity to explore home-based Judaism practices and rituals with our students through out distance learning. We are seeking the support of parents to engage family-wide learning around Shabbat, holiday, and ritual objects that students explore. This could look like student's being encouraged to light Shabbat candles at home, try leading havdallah (the closing of Shabbat) for their family, creating ritual objects, or taking nature walks.

We have the ability and are excited to support our students in elevating Judaism at home this year!

Yes!Not sure yet, need more informationNo

Is there anything else you want us to know about you, your family, or your students as we enter into the school year?

Section E: Membership

You can become eligible for ALMA reduced fees by becoming a CBI member. If you are interested in becoming a member, we would love to talk with you. CBI Membership also has Financial Accessibility rates. You may become a member by completing the CBI Membership Application here.

Are you interested in CBI Membership?

Please Select OneI am already a CBI member.I am interested in CBI membershipOther

Section F: Payment Information

Your ALMA Tuition Total is below. Upon submission, you will have the chance to decide your payment plan.

* Are you requesting Financial Aid? There are many impediments to Jewish education but finances should never be one. We ask that every family commits to some financial contribution, however we are very happy to discuss financial aid options for any dues paying family that may require tuition assistance. If you select yes, you will discuss your payment ability in a confidential meeting with the Executive Director.

Please Select OneNoYesPlease contact the Executive Director, Emily Kieval, at director@cbinorthampton.org for further conversation.

Financial Aid Follow-up: I understand and will contact Emily Kieval, Executive Director

Total Amount