Pre-Registration Request Chai Club After School Hebrew Program 24/25

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CHAI CLUB

AFTER SCHOOL HEBREW PROGRAM
20350 NE 26th Avenue, Miami, FL, 33180

Pre-Registration Request
Fall Session: September-December
Spring Session: January-May

Important note: By completing this form, you acknowledge that you are submitting a pre-registration request to the program. You will be notified via email once you are accepted in the program at which time you will have to complete the formal registration process and submit the required documents. Pre-registration requests will be accepted on first-come, first-serve basis. Limited capacity per group applies.

Registration non-refundable: $50 per student- $100 per family (2 or more students).
All Chai Club payments will be set up on a monthly payment plan upon registration.
Number of payments is dependent upon when registration form is received. Under no circumstances will payments be extended beyond the session's end date. Payments can be made by Credit Card or by e-check. Credit Card payments are subject to approximately 3% merchant processing fee.
Early Withdrawal Processing Fee:

Parent understands and agrees that a charge of $50 will be added as a withdrawal fee per child. We only accept withdrawn in writing, even if sibling remains enrolled. Monthly payments will not be refunded retroactively. Withdrawal must be communicated at least 2 weeks prior to the next payment due date.
If you have any questions regarding your payments, please contact Diana Garcia at dgarcia@btbrc.org

Chai Club Tuition Fees 2024-25
Cost $45 per class	Session	Total	Monthly

Fall Session September - December (29)	$ 1,305.00	$ 1,305.00	$ 435.00
Spring Session January - June (38)	$ 1,710.00	$ 1,710.00	$ 342.00
Full Year Sessions January- June (67)		$ 3,015.00	$ 376.88

* School Student/s Attending

All pre-registration requests are subject to space availability.

* Have you participated in the Chai Club After School Hebrew Program before?

All pre-registration requests are subject to space availability.

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 children do you intend to pre-register for Chai Club?

* Student # 1 First Name

* Student # 1 Last Name

* Student # 1 Date of Birth

* Student # 1 Grade Level as of September 2024

* I'm requesting a pre registration for the following term

Fall session September- DecemberSpring Session January- MayFull Year 2024-2025

Please complete the following

Student 1 Homeroom Teacher

Student 1 Room Number

* Student 1 Id #

* Student 1 First and Last Name

* Student # 2 First Name

* Student # 2 Last Name

* Student # 2 Date of Birth

* Student # 2 Grade Level as of September 2024

* I'm requesting a pre registration for the following term

Fall session September- DecemberSpring session January- MayFull year 2024- 2025

Please complete the following

Student 2 Homeroom Teacher

Student 2 Room Number

* Student 2 Id #

* Student 2 First and Last Name

* Student # 3 First Name

* Student # 3 Last Name

* Student # 3 Date of Birth

* Student # 3 Grade Level as of September 2024

* I'm requesting a pre registration for the following term

Fall September - DecemberSpring session January- MayFull Year 2024-2025

Please complete the following

Student 3 Homeroom Teacher

Student 3 Room Number

* Student 3 Id #

* Student 3 First and Last Name

* Please type your full name below to acknowledge you have read and agree to comply with the Beth Torah Adath Yeshurun, Inc. Chai Club pre-registration conditions set forth above. By clicking the "Submit" button below, I understand that I will be charged a non-refundable registration fee as indicated above.

Total

Tue, January 28 2025 28 Teves 5785

Pre-Registration Request Chai Club After School Hebrew Program 24/25

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