CSI Religious School Registration 2020-2021
CSI RELIGIOUS SCHOOL TUITION:

$200 deposit per child due with registration

Shorashim (Kindergarten) - $125

Prozdor 1 (1st grade), Prozdor 2 (2nd grade) - $350

Alef (3rd), Bet (4th), Gimel (5th), Dalet (6th), Heh (7th) - $1450

SECTION 1: STUDENT INFORMATION
Student 1 First Name *
Student 1 Last Name *
Student 1 Date of Birth *
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Student 1 Class *
Required
Student 1 Hebrew Name (transliterated) - if no name, please type "None" *
Student 2 First Name
Student 2 Last Name
Student 2 Date of Birth
MM
/
DD
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YYYY
Student 2 Class
Student 2 Hebrew Name (transliterated) - if no name, please type "None"
Student 3 First Name
Student 3 Last Name
Student 3 Date of Birth
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/
DD
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YYYY
Student 3 Class
Student 3 Hebrew Name (transliterated) - if no name, please type "None"
SECTION 2: FAMILY INFORMATION
Parent 1 FIRST & LAST Name *
Parent 1 Address (Street, City, State Zip) *
Parent 1 Email *
Parent 1 Phone Number(s) *
Parent 2 FIRST & LAST Name
Parent 2 Address, if different from Parent 1 (Street, City, State Zip)
Parent 2 Email
Parent 2 Phone Number(s)
Are you presently members of Congregation Sons of Israel? *
SECTION 3: AUTHORIZATIONS & EMERGENCY INFORMATION
Please complete the following. Some of the information is being collected in the event that we are able to begin in-person classes.
**Please note: Students with allergies requiring an Epi-Pen MUST have one in the school office clearly labeled with child's first & last name. By law, we cannot use an expired Epi-Pen.
Please provide if in-person classes begin.
Does Student 1 have any special needs, an IEP, allergies or other medical alerts we should know about? *
Does Student 2 have any special needs, an IEP, allergies or other medical alerts we should know about?
Does Student 3 have any special needs, an IEP, allergies or other medical alerts we should know about?
Please provide below any additional information you think we should know about your child(ren).
Pediatrician (1) Name and (2) Phone Number *
Please provide the (1) name, (2) phone number and (3) relation of PERSON(S) OTHER THAN PARENTS who are authorized to pick up your child(ren) from CSI: *
Please provide the (1) name, (2) phone number and (3) relation of PERSON(S) OTHER THAN PARENTS who may be called in the case of an emergency if a parent cannot be reached. *
Congregation Sons of Israel has a website, a Facebook presence and participates in other social media. We produce various handbooks, brochures, advertisements and DVD/videos in which we include pictures of our students, faculty and staff. Please select an option from below. *
SECTION 3: ENROLLMENT AGREEMENTS
I understand that a $200 deposit per student is required with this application. (Please make checks out to "CSI" and mail to 1666 Pleasantville Road, Briarcliff Manor, NY 10510) *
Required
I understand that all payments for tuition must be paid by the following tuition schedule: Tuition Payment Schedule: 33% of total paid by September 13, 2020; 66% paid by December 1, 2020; 100% paid by March 1, 2021 *
Required
For confidential information on financial assistance, contact Ellen Johnson, Synagogue Director at (914) 762-2700.
I understand that in order for my child(ren) to attend CSI Religious School (for in-person classes), all of my child(ren)'s vaccinations are required to be up to date. *
Required
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