Touro Synagogue’s Center for Learning & Engagement (CLE)

Student Information

How many children are you registering?*

1
2
3
4

Child's Full Name*

First Last

Child's Preferred Name/Nickname

Child's Hebrew Name

Child's Date of Birth*

Medical/Educational Information*

My child has NO ongoing conditions
My child has the following ongoing conditions:

Allergies

Medications

Medical Information

(eg. Asthma, EpiPen for Allergies)

Educational Information

(eg. LD/IEP/504, ADD/ADHD)

What grade will your child be in for the 2020/2021 school year?*

Fees are the following:
Kindergarten: $300
1st Grade - 10th Grade: $450
Uptown Hebrew (3rd-6th Grade): Additional $531 ($981 total)

Our 3rd-6th Grade Curriculum includes Uptown Hebrew lessons. If you would like more information, please contact Rabbi Silverman at 504-895-4843 or tsilverman@tourosynagogue.com.

Uptown Hebrew - Alef

3rd Grade

Price: $531.00

Uptown Hebrew - Bet

4th Grade

Price: $531.00

Uptown Hebrew - Gimmel

5th Grade

Price: $531.00

Uptown Hebrew - Dalet

6th Grade

Price: $531.00

Secular School*

School Name Grade 2020/2021

Child Email

7th - 10th Grade only

Child Cell Phone

7th - 10th Grade only

Second Child

Child's Full Name*

First Last

Child's Preferred Name/Nickname

Child's Hebrew Name

Child's Date of Birth*

Medical/Educational Information*

My child has NO ongoing conditions
My child has the following ongoing conditions:

Allergies

Medications

Medical Information

(eg. Asthma, EpiPen for Allergies)

Educational Information

(eg. LD/IEP/504, ADD/ADHD)

What grade will your child be in for the 2020/2021 school year?*

Fees are the following:
Kindergarten: $300
1st Grade - 10th Grade: $450
Uptown Hebrew (3rd-6th Grade): Additional $531 ($981 total)

Our 3rd-6th Grade Curriculum includes Uptown Hebrew lessons. If you would like more information, please contact Rabbi Silverman at 504-895-4843 or tsilverman@tourosynagogue.com.

Uptown Hebrew - Alef

3rd Grade

Price: $531.00

Uptown Hebrew - Bet

4th Grade

Price: $531.00

Uptown Hebrew - Gimmel

5th Grade

Price: $531.00

Uptown Hebrew - Dalet

6th Grade

Price: $531.00

Secular School*

School Name Grade 2020/2021

Child Email

7th - 10th Grade only

Child Cell Phone

7th - 10th Grade only

Third Child

Child's Full Name*

First Last

Child's Preferred Name/Nickname

Child's Hebrew Name

Child's Date of Birth*

Medical/Educational Information*

My child has NO ongoing conditions
My child has the following ongoing conditions:

Allergies

Medications

Medical Information

(eg. Asthma, EpiPen for Allergies)

Educational Information

(eg. LD/IEP/504, ADD/ADHD)

What grade will your child be in for the 2020/2021 school year?*

Fees are the following:
Kindergarten: $300
1st Grade - 10th Grade: $450
Uptown Hebrew (3rd-6th Grade): Additional $531 ($981 total)

Our 3rd-6th Grade Curriculum includes Uptown Hebrew lessons. If you would like more information, please contact Rabbi Silverman at 504-895-4843 or tsilverman@tourosynagogue.com.

Uptown Hebrew - Alef

3rd Grade

Price: $531.00

Uptown Hebrew - Bet

4th Grade

Price: $531.00

Uptown Hebrew - Gimmel

5th Grade

Price: $531.00

Uptown Hebrew - Dalet

6th Grade

Price: $531.00

Secular School*

School Name Grade 2020/2021

Child Email

7th - 10th Grade only

Child Cell Phone

7th - 10th Grade only

Fourth Child

Child's Full Name*

First Last

Child's Preferred Name/Nickname

Child's Hebrew Name

Child's Date of Birth*

Medical/Educational Information*

My child has NO ongoing conditions
My child has the following ongoing conditions:

Allergies

Medications

Medical Information

(eg. Asthma, EpiPen for Allergies)

Educational Information

(eg. LD/IEP/504, ADD/ADHD)

What grade will your child be in for the 2020/2021 school year?*

Fees are the following:
Kindergarten: $300
1st Grade - 10th Grade: $450
Uptown Hebrew (3rd-6th Grade): Additional $531 ($981 total)

Our 3rd-6th Grade Curriculum includes Uptown Hebrew lessons. If you would like more information, please contact Rabbi Silverman at 504-895-4843 or tsilverman@tourosynagogue.com.

Uptown Hebrew - Alef

3rd Grade

Price: $531.00

Uptown Hebrew - Bet

4th Grade

Price: $531.00

Uptown Hebrew - Gimmel

5th Grade

Price: $531.00

Uptown Hebrew - Dalet

6th Grade

Price: $531.00

Secular School*

School Name Grade 2020/2021

Child Email

7th - 10th Grade only

Child Cell Phone

7th - 10th Grade only

Family Information

Family Address*

Street Address Address Line 2 City State ZIP Code

Home Phone

if applicable

Parent 1*

First Last

Parent 1 Cell Phone*

Parent 1 Email*

Parent 2

First Last

Parent 2 Cell Phone

Parent 2 Email

Same Family Address for Parent 2?*

Yes
No

Parent 2 Address

Street Address Address Line 2 City State ZIP Code

Emergency Contact*

Emergency contact must be someone other than a parent/legal guardian over the age of 18.

First Last

Relationship*

Emergency Contact Phone*

Family Medical and Insurance Information*

This information is required in case of emergency.

Family Doctor

Name Phone Number

Insurance Information

Carrier Policy Number

Parental Consent

Weekly Participation/Off-Site Permission*

Parents will be notified in advance anytime students travel to places other than our Yamim Yafim meeting place or Touro Synagogue

I give blanket permission for my child(ren) to attend all weekly Yamim Yafim programs as well as other off-site locations including field trips.
I give blanket permission for my child(ren) to attend all weekly offsite Yamim Yafim programs; however, I will give permission for other off-site field trips on a case by case basis.

Permission for Use of Images and Recordings

I/we hereby give Touro Synagogue permission to photograph, video, and audio record my child(ren) during any Touro Synagogue event. I also acknowledge that my child(ren)'s image may be used in a variety of media - including but not limited to our website, printed materials, and social media - for purposes of marketing Touro Synagogue and it's programs. I understand that no image or recording of my child(ren) will be sold to any person or organization for any reason, nor shall any image or recording include my child(ren)'s name(s).

I AGREE to the use of my child(ren)'s image within the parameters stated above.
I DO NOT give permission for my child(ren)'s image to be used for any purpose.

Preferred Sunday Morning Time

If your family prefers one Sunday morning session over the other, please indicate it below. We will do everything we can to honor those preferences, but unfortunately cannot guarantee anyone's first choice. Thank you for understanding!

We prefer the earlier session: 9:00-10:15AM
We prefer the later session: 10:45-12:00PM
We're cool with either session!

Synagogue Membership

Membership Status

All Religious School registrations will be evaluated by our Executive Director, Kerry Tapia, in order to verify the financial good standing of each applicant family. Complete your Annual Support Pledge here.

Yes, I certify I am currently in good standing with Touro Synagogue and have submitted my 2020-21 Voluntary Annual Support Pledge
No, I am not currently up to date with my dues. I understand that registration is not complete until an annual support pledge has been made.

Fee and Payment Information

Multiple Child Discount

If you are registering more than one child you are eligible for a discount.
2 children = $18 discount
3 children = $36 discount
4 children = $54 discount

Price: $0.00

Scholarship Fund

Tuition assistance is made possible by the loving, generous donations of Touro Synagogue members, as well as those in the wider Jewish community each year; these scholarship funds are made available to families who demonstrate true financial need and a commitment to regular participation in our programs. The amount of scholarship assistance that each family receives may fluctuate from one year to the next, as we cannot guarantee that a previously-awarded amount will be possible in a subsequent year(s). Families may indicate their need for financial assistance by enrolling during the first two weeks of the registration period; after that date (July 31) we cannot guarantee that any scholarship assistance will still be available. Applicant families will be contacted by Rabbi Silverman for a confidential follow-up conversation, and then will be notified of the amount allocated soon thereafter.

We base our tuition assistance decisions on a number of factors, including (but not limited to): each family’s personal financial situation; a student’s attendance record at religious school and Uptown Hebrew in previous years; the number of families requesting scholarship funds; and the total amount of aid available this academic year. At Rabbi Silverman’s discretion, a scholarship assistance allocation will be applied to your tuition, and you will receive an updated statement.

Please keep in mind: our #1 goal is to ensure that every single Touro Synagogue family who enrolls their child(ren) in our program is able to do so without experiencing any financial stress. We will work privately, sensitively, and diligently with anyone who requests financial assistance, although we are unfortunately not able to fulfill every request each year. In general, the total scholarship allocation for each family will not exceed 50% of the full religious school tuition for each student registered.

Optional Donation to Scholarship Fund

A donation of any size to our Scholarship Fund will go a long way toward helping other Touro Synagogue families who are facing financial need. If you are able, please consider a pledge to help support our kids and families!

Donation Amount:

Is the donation in honor or in memory of someone?

No
Yes, In honor
Yes, In memory

In honor of

Name

Details of Honor (ex. Bar Mitzvah, Wedding)

In memory of

Name

Total

$0.00

Payment Options*

Credit Card

American Express

Discover

MasterCard

Visa

Card Number Expiration Date Security Code Cardholder Name

PLEASE SEND CHECKS TO:
Touro Synagogue
4238 St. Charles Avenue
New Orleans, LA 70115

You have requested to receive a partial scholarship not to exceed 50% of the total tuition. We will be in touch shortly to discuss the matter confidentially.

BANK ACCOUNT DEDUCTION (ACH DEBITS) AUTHORIZATION AGREEMENT

Complete this section to authorize ACH Debits on your selected payment plan, from your bank account to Touro Synagogue.

I request a Convenience Billing Plan for:*

Annual Support and Religious School/Uptown Hebrew Fees
Religious School/Uptown Hebrew Fees Only

How do you want your payment plan to be structured?*

Blank Voided Check*

Please attach a photo of a blank voided check to validate. Max file size is 64MB.

All debits returned by the bank for non-sufficient funds (NSF) are subject to a $25 administrative fee. Both parties must sign if joint account requires two signatures.

I (we) hereby authorize Touro Synagogue to initiate electronic debit entries to my (our)

Checking Account
Savings Account

I (we) understand that the extended payment plan is offered as a convenience. Withdrawals for payment will occur on the 15th of the month, or the first business day that follows if the 15th lands on a weekend.
I (we) acknowledge that the origination of ACH transactions to my (our) account must comply with the provisions of U.S. law.

Financial Institution*

City, State*

Account Number*

Routing Number*

Please type your name below:*

Convenience Billing Plan (Credit Card)

I request a Convenience Billing Plan for:*

Annual Support and Religious School/Uptown Hebrew Fees
Religious School/Uptown Hebrew Fees Only

How do you want your payment plan to be structured?*

I (we) understand that the extended payment plan is offered as a convenience. Withdrawals for payment will occur on the 15th of the month, or the first business day that follows if the 15th lands on a weekend.
I (we) acknowledge that the origination of credit card charges must comply with the provisions of U.S. law.

Cards Accepted: American Express, Discover, Master Card, and Visa.
A 3% processing fee will be charged.

Credit Card Number

Cardholder Name

Expiration Date

MM/YY

Security Code

Touro Synagogue’s Center for Learning & Engagement (CLE)

Student Information

Second Child

Third Child

Fourth Child

Family Information

Parental Consent

Synagogue Membership

Fee and Payment Information

BANK ACCOUNT DEDUCTION (ACH DEBITS) AUTHORIZATION AGREEMENT

Convenience Billing Plan (Credit Card)

STAY CONNECTED!