CHAI CLUB

AFTER SCHOOL HEBREW PROGRAM
20350 NE 26th Avenue, Miami, FL, 33180
Session: Fall September- December/ Spring January- June

Important note: to complete the registration process you must attach the mandatory back to club forms.
Before you complete this form Click here download the documents, save them in your computer under the student first and last name, complete, sign and submit them as indicated below. Registrations will not be accepted without the proper documents. Registration is set on first come first serve basis. Limited capacity per group applies.

* School Student/s Attending

ALL ENROLLMENTS ARE SUBJECT TO SPACE AVAILABILITY

Registration: $50 per student- $100 for family (2 or more students)
Fall session per student $568.8. See discounts below
Spring session per student $924.30. See discounts below.

All Chai Club payments will be set up on a monthly payment plan. Payment plans will be set up as follows upon registration
Fall payments end December 1, 2021

Spring payments end June 1, 2022

Family discounts:
5% off Fall, Spring and or year of tuition dues apply for families of 2 or more students.
Discounts are reflected in the prices below.
Number of payments is dependent upon when registration form is received. Under no circumstances will payments be extended beyond the session's end date. Tuition Payments will be scheduled to begin at time of registration. The card used for registration will be the card used to set up your payment plan.

Chai Club Tuition fees
Cost 23.7 per class	Session	Total	Monthly
ONE STUDENT/FAMILY
Fall Session September - December (24)	568.8	568.80	142.20
Spring Session January - June (39)	924.3	924.30	154.05
Yearly per student (63) 5% off		1418.45	141.84

TWO STUDENTS/FAMILY
Fall- Family 2 students		1109.16	277.29
Spring - Family 2 students		1802.39	300.40
Year per family of 2 students 5% off		2765.97	276.60

THREE STUDENTS/FAMILY
Fall -Family 3 students		1649.52	412.38
Spring -Family 3 students		2680.47	446.75
Year per family of 3 students 5% off		4113.49	411.35

If you have any questions regarding your payments, please contact Catalina Abello via email at Cabello@btbrc.org

* Please Intial Here

PARENT/GUARDIAN # 1

Parent/Guardian # 1 Title

* Parent/Guardian # 1 First Name

* Parent/Guardian # 1 Last Name

* Parent/Guardian # 1 Address

* Parent/Guardian # 1 City

* Parent/Guardian # 1 State

* Parent/Guardian # 1 Zip

* Parent/Guardian # 1 Cell Phone

Parent/Guardian # 1 Work Phone

* Parent/Guardian # 1 E-mail

PARENT/GUARDIAN # 2

Parent/Guardian # 2 Title

Parent/Guardian # 2 First Name

Parent/Guardian # 2 Last Name

Parent/Guardian # 2 Address

Parent/Guardian # 2 City

Parent/Guardian # 2 State

Parent/Guardian # 2 Zip

Parent/Guardian # 2 Cell Phone

Parent/Guardian # 2 Work Phone

Parent/Guardian # 2 E-mail

* How many students are you registering?

Total

* Student # 1 First Name

* Student # 1 Last Name

* Student # 1 Date of Birth

* Student # 1 Grade Level as of September 2021

* Student # 1 Gender

* Student # 1 lives with

* If Other, Please Explain

* Please register my child for the following term

Fall session September- DecemberSpring Session January- JuneFull Year 2021-2022

* Please indicate if your child needs to be escorted to the school after care program at the end of Chai Club (4:30)

After CareNot required

Please complete the following

Student 1 Homeroom Teacher

Student 1 Room Number

* Student 1 Id #

* Student 1 First and Last Name

MEDICAL INFORMATION

Student is allergic to

Treated with

Reaction

List Any Medications Your Child is Taking

* Student # 2 First Name

* Student # 2 Last Name

* Student # 2 Date of Birth

* Student # 2 Grade Level as of September 2021

* Student # 2 Gender

* Student # 2 lives with

* If Other, Please Explain

* Please register my child for the following term

Fall session September- DecemberSpring session January- JuneFull year 2021- 2022

* Please indicate if your child needs to be escorted to the after care program at the end of Chai Club (4:30)

After CareNot required

Please complete the following

Student 2 Homeroom Teacher

Student 2 Room Number

* Student 2 Id #

Student 2 First and Last Name

MEDICAL INFORMATION

Student is allergic to

Treated with

Reaction

List Any Medications Your Child is Taking

* Student # 3 First Name

* Student # 3 Last Name

* Student # 3 Date of Birth

* Student # 3 Grade Level as of September 2021

* Student # 3 Gender

* Student # 3 lives with

* If Other, Please Explain

* Please register my child for the following

Fall 2021 September - DecemberSpring session 2021-2022 January- JuneFull Year 2021-2022

* Please indicate if your child needs to be escorted to the after care program at the end of Chai Club (4:30)

After CareNot required

Please complete the following

Student 3 Homeroom Teacher

Student 3 Room Number

* Student 3 Id #

Student 3 First and Last Name

MEDICAL INFORMATION

* Student is allergic to

Treated with

Reaction

List Any Medications Your Child is Taking

EMERGENCY CONTACT #1

* Emergency Contact # 1 Full Name

* Emergency Contact # 1 Relationship

* Emergency Contact # 1 Cell Phone

EMERGENCY CONTACT #2

* Emergency Contact # 2 Full Name

* Emergency Contact # 2 Relationship

* Emergency Contact # 2 Cell Phone

Individuals Who Can Pick Up the student

First Name

Last Name

Relationship

First Name

Last Name

Relationship

Individuals Who Can NOT Pick Up the student

First Name

Last Name

Relationship

First Name

Last Name

Relationship

First Name

Last Name

Relationship

MEDICAL RELEASE

* Please Type Name of Parent/Guardian to Sign

I declare that I have provided Beth Torah Adath Yeshurun Inc, DBA Chai Club After School Hebrew Program with all information regarding my child(ren)'s health, which may reasonably be needed to meet the medical and/or physical needs of my child(ren). I further agree that I can be reached at the telephone number(s) I have provided during the hours my child(ren) is/are at Chai Club. If an emergency arises, and none of the above numbers can be contacted for any reason, I hereby authorize Beth Torah Adath Yeshurun Inc, DBA Chai Club After School Hebrew Program to seek emergency medical treatment administered by, but not restricted to, paramedics, hospital emergency room employees, and/or other medical professionals as reasonably necessary for the emergency medical treatment of my child(ren). I hereby release Beth Torah Adath Yeshurun Inc, DBA Chao Club After School Hebrew Program and its staff members from any liability resulting from any medical services provided and agree to pay for such services upon invoice. I understand that the resulting expenses will be my responsibility and not the responsibility of Beth Torah Adath Yeshurun Inc, DBA Chai Club After School Hebrew Program.

PHOTO RELEASE

* Name of Child/Children

* Please Type Name of Parent/Guardian to Sign

I agree to allow my child’s name, photograph, and information to be used by Beth Torah Adath Yehurun, DBA Chai Club After School Hebrew Program in the programs' publications, videos, promotional materials social media and website, without compensation and without prior notice. I release and hold the school harmless from any liability stemming from the use of my child’s name, photograph, or information.

RECORDS RELEASE

* Name of Child/Children

* Please Type Name of Parent / Guardian to Sign

* Name of Child/Children

PERMISSION TO RELEASE TO CHAI CLUB AFTER SCHOOL HEBREW PROGRAM

* Name of child /Children

Please Type Name of Parent / Guardian to Sign

I hereby give permission to Aventura Waterways K-8 Center and / or V.A.B.H.O.E to release my child (ren) to Beth Torah Adath Yeshurun Inc.- Chai Club at the end of the school day, during Chai Club hours of operation that there is a full day school, from the first day of the program (or at the time the student/s register) until the last day of the program.

BINDING ARBITRATION AND PREVAILING PARTY STATUS

* Name of child / children

* Please Type Name of Parent / Guardian to Sign

We believe that arbitration is the most appropriate way to resolve any disupte that may arise between Beth Torah Adath Yeshurun Inc. and you. By signing this application, you and Beth Torah Adath Yeshurun INC, DBA agree that any and all disputes arising out of or related to your child's enrollment in Beth Torah Adath Yeshurun INC, DBA, or to any other aspect of the relationship between you and / or your child, on the one hand, and Beth Torah Adath Yeshurun INC, DBA or any of its employees, on the other, shall be heard and determined exclusively by final and binding arbitration before a single arbitrator under the Commercial Arbitration Rules of the American Arbitration Association, in Miami Dade- County, Florida judgement upon the arbitration award may be entered in any court of competent jurisdiction. The substantive laws shall be applied in resolving any such dispute. Agreeing to final and binding arbitration means forgoing many elements of litigation in court, most notably detailed discovery, trial by jury, and right to appeal. Beth Torah Adath Yeshurun INC, DBA believes that the advantages of relative speed and economy, and confidentiality, outweigh any disadvantages. Should you have any questions regarding this choice of process, we recommend that you consult with counsel prior to signing this application. The prevailing party in the arbitration proceeding shall be awarded all costs and reasonable attorney's fees in an amount determined by the arbitrator. Such and award shall include the costs and reasonable attorney's fees incurred in the arbitration proceeding as well as the costs and reasonable attorney's fees incurred in preparing for and attending any scheduled mediation.

RELEASE OF LIABILITY

Name of child / children

Please Type Name of Parent / Guardian to Sign

I, parent/guardian give permission to my child/ren to participate in all scheduled program activities and events at or associated with Beth Torah Adath Yeshrun Inc.
I, parent/guardian assume all risks and hazards incidental to or resulting from the negligence, failure of care, omission or other acts howsoever caused by Beth Torah Adath Yeshurun Inc, DBA or the organizers, sponsors, volunteers, and anyone connected with the program or activity for any and all liability for personal injuries including death and property losses or damage resulting from my son/daughter's participation in any activity associated with the above mentioned organization. The undersigned has read this release, understand its contents, and executes it voluntary with full knowledge of its significance.

Form upload

Before uploading the files: make sure all files are properly completed, and saved in your computer. Forms are to be submitted by individual students.

* Please initial below that you have read the Beth Torah Adath Yeshrun Inc. - Chai Club, and I understand and agree to comply with all of the conditions stated herein.

Grand Total

Chai Club After School Hebrew Program 21/22

Registration: $50 per student- $100 for family (2 or more students)
Fall session per student $568.8. See discounts below
Spring session per student $924.30. See discounts below.

CONTACT US

ADDRESS

MAIN OFFICE PHONE

E-MAIL

Chai Club After School Hebrew Program 21/22

Registration: $50 per student- $100 for family (2 or more students) Fall session per student $568.8. See discounts below Spring session per student $924.30. See discounts below.

CONTACT US

ADDRESS

MAIN OFFICE PHONE

E-MAIL

Registration: $50 per student- $100 for family (2 or more students)
Fall session per student $568.8. See discounts below
Spring session per student $924.30. See discounts below.