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Religious School Registration
Please verify reCaptcha before submitting the form.
To bill your account, you must log in to ShulCloud on the top right hand corner.
If you need assistance, you can call the offi
ce at 225-924-6773.
2023-2024 RELIGIOUS SCHOOL
TUITION
Preschool - 4th: $380
Grades 5-7: $700
Pre-Confirmation: $370
Confirmation: $370
M&Ms: FREE
Please complete all of the following information. If you have any questions regarding Religious School, please contact Julie Tepper at rsdirector@ujcbr.org.
PARENT 1 NAME (and main contact)
PARENT 1 EMAIL
PARENT 1 MOBILE PHONE
ADDRESS
CITY
STATE
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
ZIP
Membership Status
None Selected
We are UJCBR Members
We are not members but are interested in an application for membership
PARENT 2 NAME
PARENT 2 EMAIL
PARENT 2 MOBILE PHONE
ADRESS OF PARENT 2 IF DIFFERENT THAN PARENT 1
NAME
RELIGIOUS SCHOOL GRADE
None Selected
Grade Pre-K 3 ($380)
Grade Pre-K 4 ($380)
Kindergarten ($380)
Grade 1 ($380)
Grade 2 ($380)
Grade 3 ($380)
Grade 4 ($380)
Grade 5 ($700)
Grade 6 ($700)
Grade 7 ($700)
Pre-Confirmation ($370)
Confirmation ($370)
Mini Mishpocha Parent and Me Playtime: M&Ms ($0)
HEBREW NAME (if known)
DATE OF BIRTH
AGE
*
NAME OF SCHOOL ATTENDING IN 2023/2024
*
GRADE ENTERING IN SCHOOL YEAR 2023/2024
*
HEALTH (list all health concerns, and /or learning or behavioral issues)
*
ALLERGIES / DIETARY (list all allergies & dietary restrictions)
*
MEDICATIONS (list all medications)
Check if child takes medication on Sundays
Check if child takes medication on Sundays
Time needed to administer medicine
NAME
RELIGIOUS SCHOOL GRADE
None Selected
Grade Pre-K 3 ($380)
Grade Pre-K 4 ($380)
Kindergarten ($380)
Grade 1 ($380)
Grade 2 ($380)
Grade 3 ($380)
Grade 4 ($380)
Grade 5 ($700)
Grade 6 ($700)
Grade 7 ($700)
Pre-Confirmation ($370)
Confirmation ($370)
Mini Mishpocha Parent and Me Playtime: M&Ms
HEBREW NAME (if known)
DATE OF BIRTH
AGE
NAME OF SCHOOL ATTENDING IN 2023/2024
GRADE ENTERING IN SCHOOL YEAR 2023/2024
ALLERGIES / DIETARY (list all allergies & dietary restrictions)
HEALTH (list all health concerns, and /or learning or behavioral issues)
MEDICATIONS (list all medications)
Check if CHILD takes medication on Sundays
Check if CHILD takes medication on Sundays
Time needed to administer medication
NAME
RELIGIOUS SCHOOL GRADE
None Selected
Grade Pre-K 3 ($380)
Grade Pre-K 4 ($380)
Kindergarten ($380)
Grade 1 ($380)
Grade 2 ($380)
Grade 3 ($380)
Grade 4 ($380)
Grade 5 ($700)
Grade 6 ($700)
Grade 7 ($700)
Pre-Confirmation ($370)
Confirmation ($370)
Mini Mishpocha Parent and Me Playtime: M&Ms ($0)
HEBREW NAME (if known)
DATE OF BIRTH
AGE
NAME OF SCHOOL ATTENDING IN 2023/2024
GRADE ENTERING IN SCHOOL YEAR 2023/2024
ALLERGIES / DIETARY (list all allergies & dietary restrictions)
HEALTH (list all health concerns, and /or learning or behavioral issues)
MEDICATIONS (list all medications)
Check if child takes medication on Sundays
Check if child takes medication on Sundays
Time to administer medicine
NAME
RELIGIOUS SCHOOL GRADE
None Selected
Grade Pre-K 3 ($380)
Grade Pre-K 4 ($380)
Kindergarten ($380)
Grade 1 ($380)
Grade 2 ($380)
Grade 3 ($380)
Grade 4 ($380)
Grade 5 ($700)
Grade 6 ($700)
Grade 7 ($700)
Pre-Confirmation ($370)
Confirmation ($370)
Mini Mishpocha Parent and Me Playtime: M&Ms ($0)
HEBREW NAME (if known)
DATE OF BIRTH
AGE
NAME OF SCHOOL ATTENDING IN 2023/2024
GRADE ENTERING IN SCHOOL YEAR 2023/2024
HEALTH (list all health concerns, and /or learning or behavioral issues)
HEALTH (list all health concerns, and /or learning or behavioral issues)
MEDICATIONS (list all medications)
Check if child takes medication on Sundays
Check if child takes medication on Sundays
Time to administer medicine
TOTAL RELIGIOUS SCHOOL FEES
*
I will pay by the following (you must be logged in to your ShulCloud acct to be billed):
Please Select One
None Selected
I will pay in full now by credit card (enter information on payment page)
I will pay a portion now by credit card (bill my account for balance)
Bill my account in full (you must be signed in to ShulCloud to be billed)
Bill my account quarterly through the school year (you must be signed in to ShulCloud to be billed and send email to office@ujcbr.org indicating how you want to be billed)
I will set up Auto Pay - send me a form to submit (you must be signed in to ShulCloud to be billed)
EMERGENCY CONTACT INFORMATION
*
Emergency Contact Name
*
Emergency Contact Phone Number
*
Physician's Name
*
Physician's Phone Number
*
Are all children current on all immunizations?
Please Select One
No reply
Yes
No
*
Comments / Notes
I authorize the staff of UJCBR Religious School to engage such professional medical care or hospital laboratory services as may appear to be necessary or desirable for the protection of the health or life of my minor child(ren) on this registration form. Further, I agree to be responsible for any charges incurred in the rendition of such care and treatment.
I AGREE - Please check here for authorization
I AGREE - Please check here for authorization
I agree to pay the above tuition in full or will make financial arrangements with the UJCBR Executive Director
I AGREE - Please check here for authorization
I AGREE - Please check here for authorization
To request tuition assistance click on the box below and/or please contact
Julie Tepper (RSDirector@ujcbr.org) or Heather Bourgeois ( Heather@ujcbr.org) for more information.
Financial assistance will be done with utmost confidentiality.
Please contact me about financial assistance
Please contact me about financial assistance
ENTERING MY FULL NAME IS MY ELECTRONIC SIGNATURE.
Date of Digital Signature
Wed, May 31 2023
11 Sivan 5783
Upcoming Programs & Events
Jun
9
ShabbaBBQ
Friday, Jun 9 5:00pm
Jun
11
Jewish Book Club
Sunday, Jun 11 1:00pm
Jul
16
Jewish Book Club
Sunday, Jul 16 1:00pm
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Parshat Nasso
Shabbat, Jun 3
Shabbat Mevarchim
Shabbat, Jun 17
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Wed, May 31 2023 11 Sivan 5783
