Congregation B'nai B'rith www.cbbsb.org 1000 San Antonio Creek Road, Santa Barbara, CA 93111 (805) 964-7869
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Jewish Learning Programs at CBB                                                           Registration Form           2018/19 School Year

Religious School Logo
Welcome to the Jewish Learning Programs at CBB

For important program and tuition information, including changes for the 2018/19 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 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 matches directly to our data base.

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

If you are not currently a CBB member and you would like to enroll your child in our Jewish Learning Programs, 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.

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 enrolling in Jewish Learning Programs 2018-2019! 
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  - ONLY FILL THIS SECTION OUT IF INFORMATION HAS CHANGED!











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 







Other Information




Child 2 Information







Child 2 - School Information
















Medical Information - Child 2 







Other Information




Child 3 Information







Child 3 - School Information
















Medical Information - Child 3 







Other Information




Child 4 Information







Child 4 - School Information
















Medical Information - Child 4 







Other Information



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.  Do not include either parent in these contact fields below, please.















Permissions






Parent Volunteers


Tuition by Child 

$

$

$

$

$
Sibling Discount and Total Tuition 


$

$

$
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)

If you check yes you will see a statement in red at the end of the form: There was an error computing this field. Just ignore that and submit. Thank you.


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




You can choose your first payment date in the field above, for any date at least three days after you submit the form. For the Early Registration Discount your first (or only) payment must be by July 31st.

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




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THANK YOU for registering for Jewish Learning Programs at CBB!

PLEASE CLICK SUBMIT.

If you have general questions about this or any event you may call our front office at (805) 964-7869