Jewish Learning Programs at CBB                                                           Registration Form           2016/17 School Year

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Welcome to the Jewish Learning Programs at CBB

For important program and tuition information, including changes for the 2016/17 year, please visit our website: www.cbbsb.org.

To fill out the form you will need:
-medical insurance information for each child
-doctor name and phone number
-emergency contacts, at least one local and one out of state, with a cell phone for each

IMPORTANT INFO about the form - PLEASE READ
Please fill in registration information for each child. The physician and emergency contacts information, as well as field trip and media permissions will apply to all children in your family. 
All fields with an * are required.

Please use capital letters for the first letter of names, streets, etc. 
DO NOT use all capital letters or all small case letters as this info goes directly into our data base.

After you fill out the form you will be asked to confirm your information and then submit. Your form will not process until you click the submit button the second time.

Sibling Discount: If you are registering more than one child, you will receive 5% off your total tuition.

If you are not currently a CBB member and you would like to enroll your child in a Jewish Learning Program, please contact Elizabeth Gaynes, CBB Executive Director, before you fill out the form, at 805-964-7869 or elizabeth@cbbsb.org. Students enrolled in Jewish Learning Programs must be members of CBB. 

For any questions regarding our Jewish Learning Programs please contact Jen Lewis, Director of Jewish Learning Programs at 805-964-7869, x225 or jen@cbbsb.org.

This is the first year we are using an online form, so if you have any questions about payments please contact Terry Grimes at 805-964-7869 x119 or terry@cbbsb.org.

The form uses a security protocol (SSL), resulting in encryption of data transmitted.
Fields with an * are required.

Thank you for signing up for Jewish Learning Programs 2016-2017! 
Parent/Guardian 1 Information

PLEASE use capital letters for the first letter only for all first and last names. Example: Jacob Katz
Do not use all capital letters or all small case letters










Parent/Guardian 2 Information











Number of Children to Register 

Child 1 Information

PLEASE use capital letters for the first letter only for all first and last names. Example: Jacob Katz
Do not use all capital letters or all small case letters







Child 1 - School Information















Medical Information - Child 1 







T-shirt size 

Child 2 Information







Child 2 - School Information















Medical Information - Child 2 







T-shirt size 

Child 3 Information







Child 3 - School Information















Medical Information - Child 3 







T-shirt size 

Child 4 Information







Child 4 - School Information















Medical Information - Child 4 







T-shirt size 

Insurance Information - Child 1




Insurance Information - Child 2

Insurance Information - Child 3

Insurance Information - Child 4

Physician and Emergency Contacts

Physician and Emergency contact information (fill in one time for all children registered): Please list name, relationship (who the person is to your child, e.g. Uncle), and phone number(s), for at least two and up to three people we may contact in the event of an emergency when you cannot be reached. These should be someone other than parents of the child.















Permissions




Tuition by Child 

$

$

$

$

$
Sibling Discount 


$

$

$
IMPORTANT NOTE: After you finish the rest of the form and click submit, you will see the beginning of the form again with your info filled in. You must click Confirm at the bottom to send the information to us.
Financial Aid


It is CBB’s policy to admit all members’ children to its Jewish Learning Programs regardless of ability to pay.  If you need financial assistance, please submit a  separate Financial Aid Request form. You can obtain a form from the CBB office or online at www.cbbsb.org. Please return completed form as soon as possible to Elizabeth Gaynes, elizabeth@cbbsb.org or to the office. We will follow up with you about payment after we receive your application.  NOTE: You will need to know the total tuition amount from this form. (See Total Tuition After Discount, above)


Additional Contribution

Please consider making a tax-deductible gift towards the cost of Jewish Learning for a child in need of financial assistance. Thank you!




$
Payment Plans




1st payment must be by September 30. Input as MM/DD/YYYY.  You can choose your first payment date in the field above.

If paying by check, make it out to CBB, send to CBB/Jewish Learning, 1000 San Antonio Creek Road, Santa Barbara, CA 93111
For credit card: Please fill in your credit or debit card information in the secure fields below.

 Final Total

$


$

$

$
Credit Card Payment Information - Secure Transaction




MM

YYYY







THANK YOU for registering for Jewish Learning Programs at CBB! 
Once you click submit you will be able to review your answers and YOU MUST CLICK SUBMIT on the review page.
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