Jewish Learning Programs at CBB Registration Form 2023/24 School Year

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Jewish Learning Programs at CBB Registration Form 2023/24 School Year

Welcome to the Jewish Learning Programs at CBB

For important program and tuition information, including changes for the 2023/24 year, please visit our website by clicking here.

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

All fields with an * are required.

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.

Sibling Discount: If you are registering more than one child, you will receive 5% off your total tuition. Be sure to check the sibling discount.

CBB Temple Membership is required for all families enrolled in our Jewish Learning Programs. Membership is valid when dues are paid. If you are not currently a CBB member and you would like to enroll your child in our Jewish Learning Programs, you'll need to become a member within 30 days of enrollment. Enroll your students now, and then fill out the "New Member" form when it becomes available.

For more information about membership, contact Elizabeth Gaynes, CBB's Executive Director, at (805) 964-7869 or elizabeth@cbbsb.org.

For questions regarding our Jewish Learning Programs please contact Jen Lewis, Director of Jewish Learning Programs at (805) 964-7869 x336 or jen@cbbsb.org.

With questions about payments please contact Bookkeeper Terry Grimes at (805) 964-7869 x119 or terry@cbbsb.org.

The form uses a security protocol (SSL), resulting in encryption of data transmitted.

Thank you for enrolling in Jewish Learning Programs 2023-2024!

Members of CBB?

Members of CBB. Thank you for your continued membership. Please proceed with the enrollment form.Non-Members of CBB

I understand that our family must become members of CBB in order to attend Jewish Learning Programs at CBB. (Check to accept acknowledgement)

I commit to arranging membership within 30 days of completing registration, by filling out the "New Member Form", submitting a membership commitment, and reaching out to Elizabeth Gaynes or Mariela Socolovsky at (805) 964-7869. (Check to accept acknowledgement).

I am aware that I will not be turned away for lack of ability to pay tuition or membership commitment and that financial aid is available to me. (Check to accept acknowledgement)

Parent/Guardian 1 Information

Parent/Guardian 1 First Name

Parent/Guardian 1 Last Name

Parent/Guardian 1 Email (Please use the email you use for other CBB correspondence.)

Parent/Guardian 1 Alternate Email, if applicable.

Street Address

City

State

Postal/Zip Code

Cell Phone Number

Primary Household Phone Number

Work Phone Number

Click one option below to designate as your Household Primary Phone

Parent 1 HomeParent 1 CellParent 2 Cell

Account Phone Calculated

Add / Update Parent 2 in your Household?

Yes add Parent 2Not Applicable / Different Household

Is Parent 1 or Parent 2 completing this registration?

Parent 1Parent 2

(Parent selected above will receive the confirmation email on completion.)

Parent/Guardian 2 Information

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Email (Please use the email you use for other CBB correspondence.)

Cell Phone Number

Home Phone

Work Phone Number

Check here if address is different than Parent 1 and then fill in below

Parent /Guardian 2 address

Street Address

City

State

Postal/Zip Code

Parent Email Receipt Section (for Email Autoresponder)

Parent Receipt Name Calculation

Parent Receipt Email Address Calculation

Number of Children to Register

How many children under 18 are you registering for JLP (K-12)?

Child 1 Information

Child 1 First Name

Child 1 Last Name

Date of Birth

Child 1 Lives with

Child 1 - If you checked 'other' in the question above, please describe living situation

Nickname/Name child goes by if different from First Name

Hebrew name

Child 1 - School Information

JLP grade in Fall 2023 Child 1

OPTION: The Hebrew Immersion Program, HIP, is a supplemental program for K-3rd grade. To start or continue in HIP, please enroll via the question below. NOTE: Once registered, Jen will be in touch with you about the weekly schedule. You can find more info about this program at www.cbbsb.org.

OPTION: 2nd Grade Continuing Enrollment in HIP: The Hebrew Immersion Program, HIP, is a supplemental program for K-3rd grade. This option is only available if your child was enrolled during 1st grade in HIP. If you would like to continue, please enroll below. NOTE: Once registered, Jen will be in touch with you about the weekly schedule. You can find more info about this program at www.cbbsb.org .

3rd Grade has TWO SEPARATE, OPTIONAL Hebrew Supplemental programs in addition to the regular Sunday morning program.

1. Continuing Enrollment in HIP (Prerequisite - 2nd grade HIP): The Hebrew Immersion Program, HIP, is for K-3rd grade. If your child was in HIP for 2nd grade and you want to continue, please enroll below. NOTE: Jen will be in touch with you about the weekly schedule.
2. Hebrew Weekday Option: If your child is eager to begin Hebrew studies, this is for you! No previous enrollment required. Enroll below for semi-private lessons. Jen will be in touch about scheduling. You can find more info about these programs at www.cbbsb.org.

3rd grade Weekday Hebrew Option - Enrollment for Child 1

Hebrew Immersion Program (HIP) - Enrollment for Child 1

Child 1 Senior Seminar / Confirmation

Senior Seminar/Confirmation a monthly additional class and is offered FREE to 12^th graders if enrolled in Mechina

Senior Seminar / Confirmation - Enrollment for Child 1

Public/Private school grade in Fall 2023

Public/Private School Name

Other School Name

Does Child 1 have an IEP (Individualized Education Plan) or 504 in their secular school?

YesNo

Child 1 Relevant IEP conditions or accommodations:

Child 1 - What information should we have concerning your child’s development or special interests? (Gifted, learning disabilities, physical limitations, classroom accommodations,etc.)

Medical Information - Child 1 - required

Does Child 1 have any allergies?

NoYes

Please list any allergies

Does Child 1 take any medications?

NoYes

Current Medications

Does Child 1 have any medical conditions or specials needs?

NoYes

Child 1 Medical Conditions or Special Needs

For Child 1, are there any other conditions or challenges of which we should be aware?

Other Information

Child 1: T-shirt size, choose one

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XL

Student #1 Email Address (7th-12th grade only! To be used for Parent Square, Class info, Youth Groups and Community Service Opportunities.)

Student #1 Cell Phone (7th-12th grade only! To be used for Parent Square, Class info, Youth Groups and Community Service Opportunities.)

Child 2 Information

Child 2 First Name

Child 2 Last Name

Date of Birth

Child 2 Lives with

Child 2 - If you checked 'other' in the question above, please describe living situation

Nickname/Name child 2 goes by if different from First Name

Hebrew name 2 (if you know it, in English transliteration, if you filled this in last year you do not need to fill it in again )

Child 2 - School Information

JLP grade in Fall 2023 Child 2

OPTION: 2nd Grade Continuing Enrollment in HIP: The Hebrew Immersion Program, HIP, is a supplemental program for K-3rd grade. This option is only available if your child was enrolled during 1st grade in HIP. If you would like to continue, please enroll below. NOTE: Once registered, Jen will be in touch with you about the weekly schedule.
You can find more info about this program at www.cbbsb.org .

3rd Grade has TWO SEPARATE, OPTIONAL Hebrew Supplemental programs in addition to the regular Sunday morning program.
1. Continuing Enrollment in HIP (Prerequisite - 2nd grade HIP): The Hebrew Immersion Program, HIP, is for K-3rd grade. If your child was in HIP for 2nd grade and you would like to continue, please enroll below. NOTE: Once registered, Jen will be in touch with you about the weekly schedule.

2. NEW! Hebrew Weekday Option: If your child is eager to begin Hebrew studies, this is for you! No previous enrollment required. Enroll below for semi-private lessons. Jen will be in touch about scheduling. You can find more info about these programs at www.cbbsb.org.

3rd grade HIP or Weekday Hebrew Option - Enrollment for Child 2

Hebrew Immersion Plan (HIP) - Enrollment for Child 2

Child 2 Senior Seminar / Confirmation

Senior Seminar/Confirmation a monthly additional class and is offered FREE to 12^th graders if enrolled in Mechina

Senior Seminar / Confirmation - Enrollment for Child 2

Public/Private school grade in Fall 2023

Public/Private School Name

Other School Name

Does Child 2 have an IEP (Individualized Education Plan) or 504 in their secular school?

YesNo

Child 2 Relevant IEP conditions or accommodations:

Child 2 - What information should we have concerning your child’s development or special interests? (Gifted, learning disabilities, physical limitations, classroom accommodations,etc.)

Medical Information - Child 2 - required

Does Child 2 have any allergies?

NoYes

Please list any allergies

Does Child 2 take any medications?

NoYes

Current Medications

Does Child 2 have any medical conditions or special needs?

NoYes

Child 2 Medical Conditions or Special Needs

For Child 2, are there any other conditions or challenges which we should be aware of?

Other Information

Child 2: T-shirt size, choose one

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XL

Student #2 Email Address (7th-12th grade only! To be used for Youth Groups and Community Service Opportunities.)

Student #2 Cell Phone (7th-12th grade only! To be used for Youth Groups and Community Service Opportunities.)

Child 3 Information

Child 3 First Name

Child 3 Last Name

Date of Birth

Child 3 Lives with

Child 3 - If you checked 'other' in the question above, please describe living situation

Nickname/Name child 3 goes by if different from First Name

Hebrew name 3 (if you know it, in English transliteration, if you filled this in last year you do not need to fill it in again)

Child 3 - School Information

JLP grade in Fall 2023 Child 3

3rd Grade has TWO SEPARATE, OPTIONAL Hebrew Supplemental programs in addition to the regular Sunday morning program.
1. Continuing Enrollment in HIP (Prerequisite - 2nd grade HIP): The Hebrew Immersion Program, HIP, is for K-3rd grade. If your child was in HIP for 2nd grade and you would like to continue, please enroll below. NOTE: Once registered, Jen will be in touch with you about the weekly schedule.
2. NEW! Hebrew Weekday Option: If your child is eager to begin Hebrew studies, this is for you! No previous enrollment required. Enroll below for semi-private lessons. Jen will be in touch about scheduling. You can find more info about these programs at www.cbbsb.org.

3rd grade HIP or Weekday Hebrew Option - Enrollment for Child 3

Hebrew Immersion Program (HIP) - Enrollment for Child 3

Child 3 Senior Seminar / Confirmation

Senior Seminar/Confirmation a monthly additional class and is offered FREE to 12^th graders if enrolled in Mechina

Senior Seminar / Confirmation - Enrollment for Child 3

Public/Private school grade in Fall 2022

Public/Private School Name

Other School Name

Does Child 3 have an IEP (Individualized Education Plan) or 504 in their secular school?

YesNo

Child 3 Relevant IEP conditions or accommodations:

Child 3 - What information should we have concerning your child’s development or special interests? (Gifted, learning disabilities, physical limitations, classroom accommodations,etc.)

Medical Information - Child 3 - required

Does Child 3 have any allergies?

NoYes

Please list any allergies

Does Child 3 take any medications?

NoYes

Current Medications

Does Child 3 have any medical conditions or special needs?

NoYes

Child 3 Medical Conditions or Special Needs

For Child 3, are there any other conditions or challenges which we should be aware of?

Other Information

Child 3: T-shirt size, choose one

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XL

Student #3 Email Address (7th-12th grade only! To be used for Youth Groups and Community Service Opportunities.)

Student #3 Cell Phone (7th-12th grade only! To be used for Youth Groups and Community Service Opportunities.)

Child 4 Information

Child 4 First Name

Child 4 Last Name

Date of Birth

Child 4 Lives with

Child 4 - If you checked 'other' in the question above, please describe living situation

Nickname/Name child 4 goes by if different from First Name

Hebrew name 4 (if you know it, in English transliteration, if you filled this in last year you do not need to fill it in again)

Child 4 - School Information

JLP grade in Fall 2023 Child 4

OPTION: The Hebrew Immersion Program, HIP, is a supplemental program for K-3rd grade. To start or continue in HIP, please enroll via the question below. NOTE: You will have the option to choose the class meeting before OR after regular Sunday class, plus either Wednesday OR Thursday afternoon. Once registered, Jen will be in touch with you about the options. You can find more info about this program at www.cbbsb.org.

OPTION: Continuing Enrollment in HIP: The Hebrew Immersion Program, HIP, is a supplemental program for K-3rd grade. This option is only available if your child was enrolled during 1st grade in HIP. If you would like to continue, please enroll below. NOTE: Classes meet before OR after regular Sunday class, plus either Wednesday OR Thursday afternoon. Once registered, Jen will be in touch with you about the options. You can find more info about this program at www.cbbsb.org.

3rd Grade has TWO SEPARATE, OPTIONAL Hebrew Supplemental programs in addition to the regular Sunday morning program.

1. Continuing Enrollment in HIP (Prerequisite - 2nd grade HIP): The Hebrew Immersion Program, HIP, is for K-3rd grade. If your child was in HIP for 2nd grade and you would like to continue, please enroll below. NOTE: Class will now meet before OR after regular Sunday class, plus either Wednesday OR Thursday afternoon. Once registered, Jen will be in touch with you about the options.We strive to find a good fit for each student's schedule.

2. NEW! Hebrew Weekday Option: If your child is eager to begin Hebrew studies, this is for you! No previous enrollment required. Enroll below and then another question will pop up for you to select your preferred day and time. You can find more info about these programs at www.cbbsb.org.

3rd grade HIP or Weekday Hebrew Option - Enrollment for Child 4

Hebrew Immersion Program (HIP) - Enrollment for Child 4

Child 4 Senior Seminar / Confirmation

Senior Seminar/Confirmation a monthly additional class and is offered FREE to 12^th graders if enrolled in Mechina

Senior Seminar / Confirmation - Enrollment for Child 4

Public/Private school grade in Fall 2023

Public/Private School Name

Other School Name

Does Child 4 have an IEP (Individualized Education Plan) or 504 in their secular school?

YesNo

Child 4 Relevant IEP conditions or accommodations:

Child 4 - What information should we have concerning your child’s development or special interests? (Gifted, learning disabilities, physical limitations, classroom accommodations,etc.)

Medical Information - Child 4 - required

Does Child 4 have any allergies?

NoYes

Please list any allergies

Does Child 4 take any medications?

NoYes

Current Medications

Does Child 4 have any medical conditions or specials needs?

NoYes

Child 4 Medical Conditions or Special Needs

For Child 4, are there any other conditions or challenges which we should be aware of?

Other Information

Child 4: T-shirt size, choose one

Youth SmallYouth MediumYouth LargeAdult SmallAdult MediumAdult LargeAdult XL

Student #4 Email Address (7th-12th grade only! To be used for Youth Groups and Community Service Opportunities.)

Student #4 Cell Phone (7th-12th grade only! To be used for Youth Groups and Community Service Opportunities.)

Insurance Information - Child 1

Subscriber Name for Insurance

Insurance Company Name

Insurance ID#

Insurance Group # or Contract Code

Insurance Information - Child 2

Insurance ID# Child 2

Insurance Information - Child 3

Insurance ID# Child 3

Insurance Information - Child 4

Insurance ID# Child 4

Physician and Emergency Contacts

This information is required.

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.

Physician Info

Physician's Name

Physician's Phone Number

Emergency Contact 1

Emergency Contact #1 Name

Relationship #1

Cell Phone #1

Home Phone #1

Work Phone #1

Out of State Emergency Contact

Out of State Emergency Contact #2 Name

Relationship #2

Cell Phone #2

Home Phone #2

Work Phone #2

Add Additional Contact? (#3)

YesNo

Additional Contact #3

Additional Contact #3 Name

Relationship #3

Cell Phone #3

Permissions - Response Required

COVID Protocols: I will abide by the school's current COVID protocols.

Yes I agree

Internal Media - I grant to Congregation B’nai B’rith (CBB) the right to photograph or record my dependent(s) and to use the photo and/or any digital or other reproduction of him/her or his/her physical likeness (all of which shall be the exclusive property of CBB), for publication processes, including electronic media, print media or electronic publishing via the Internet, internally for CBB members (i.e. weekly and monthly Program Guides, Voices Magazine, Parent Square, etc...)

Agree

External Media - - I grant to Congregation B’nai B’rith (CBB) the right to photograph or record my dependent(s) and to use the photo and/or any digital or other reproduction of him/her or his/her physical likeness (all of which shall be the exclusive property of CBB), for publication processes, including electronic media, print media or electronic publishing via the Internet, externally for advertisements or promotion. (i.e. news articles, CBB Facebook page, JLP Instagram, CBB You Tube Channel, etc...)

AgreeDisagree - I will contact JLP office

School Directory - I agree to participate in Parent Square, the JLP communication website app. By doing so, I give permission for my contact information to be available to other enrolled families in the "Directory" tab of the site. Only enrolled families and staff have access to our Parent Square community directory.

Agree

Parent Initials

Today's Date

Parent Volunteers

Parent Volunteer Opportunities

Yes! I am interested in taking a leadership role as a member of the Family Engagement Committee within the Jewish Learning Programs.Sorry, I am not interested at this time.

Building a strong Jewish Community is one of our goals. We need help to make it happen. Please let us know the ways in which you'd like to participate! Select as many that interest you.

Parent Opportunities to volunteer are:

Classroom CommunicationsPurim CarnivalPurim RafflePassover SederTot Shabbat (Pre-3rd) and Jr. Shabbat (3rd-6th grades)BirthdaysTeacher AppreciationParent Engagement CommitteeSCRIP FundraisingHosting a class event in my home (when safe to do so)Hosting an adult event in my home (when safe to do so)School wide special events (ie. beach day or havdalah picnic)

Tuition by Child

Child 1

Child 2

Child 3

Child 4

Total ANNUAL Tuition

Early Bird Discount (Note all tuition pricing listed is ANNUAL)

Early Registration 5% discount on total tuition - I am registering by Friday, July 1st and my first (or only) payment will be paid by Friday, July 15th. Otherwise first (or only) payment must be made by September 9th.

Confirmed

Early Registration Discount Amount

Sibling Discount

Sibling Discount 5% discount on total tuition - I am registering more than one child

YesNo

Sibling Discount Amount

Discount Totals

Total Discount Amount (If Applicable)

Total Tuition After Discount

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)

I am applying for financial aid

Yes I am applying for financial aid No I am not applying for financial aid at this time

Additional Contribution Note

Had a section to add a gift on top of the tuition. All (Jen, Ron, Terry) agreed that this was a bit much to ask on top and they would never want to add it back in. "Donation Amount" field had variable "totalwdonation" however this was improperly implemented - see prev year's form. Variable was replaced where referenced below. -RF

Payment Method

I am paying by

Check to be sent in to CBBCredit or debit card

Offset Credit Card Fees

Credit Card Offset Note

Originally "3% Contribution" below was "if(payfee==1){(totalwdonation*.03).toFixed(2)}else{0}". This used the "totalwdonation" variable to calculate the largest value to apply the offset to, however with the donation being hidden this won't function correctly. Also it would be 0 until payfee was chosen. Therefore I am changing the formula below to use the "tuitionwdiscount" formula instead and display whether or not the value was selected, using "(tuitionwdiscount*.03).toFixed(2)" and updating the final tuition to reflect the choice instead using"if(payfee==1){(tuitionwdiscount+threepct).toFixed(2)}else{tuitionwdiscount.toFixed(2)}". Also renamed the variable to be more accurate. If you want to enable an optional donation in the future, you will need to determine where to apply covering the fees - would make the most sense to me to have this apply separately to each "item"- the donation "item" AND the tuition "item" separately NOT together. -RF

Please consider a courtesy tax-deductible contribution of 3% at this time to offset credit card processing fees. We appreciate your gift!

Yes, I am covering feesNo, I will not be covering fees at this time

3% Contribution

Tuition Total plus 3% contribution

Final Tuition

Payment Plans

Preferred Payment Plan for Payment by Check

1 payment 4 payments - quarterly

Preferred Payment Plan for Credit or Debit card

1 payment 4 payments - quarterly10 monthly payments (credit or debit card only)

Subscription frequency is

Subscription frequency is (2) note

"Subscription frequency is (2)" is being mapped to the Auth.net "Recurring Billing." It is calculated where if "Preferred Payment Plan for Credit" is 4 (aka credit card field is 4 payments) it sets the value to 3 otherwise it's 1. This sets the months between installments, which makes sense (quarterly = every 3 months, monthly = every 1 month) although it means other forms were set up improperly - see the Membership form for 21-22 which maps 1, 4, 10 which to mean implies it should bill every 4 or 10 months!. -RF

Subscription frequency is (2)

1st Payment Date field HIDDEN note

Removed the field "1st Payment Date (must be at least three days after date of form submission)" because in the Auth.net connector you can set start date to be "+3 days".

Please make check 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.

NOTE: Your credit card will be charged 3 days from today.

For credit card: Please fill in your credit or debit card information in the secure fields below.

NOTE: During the Early Bird registration period, your credit card will not be charged until July 5.

Paying Now

Amount To Charge Now

Credit Card Payment Information - Secure Transaction

First Name on Card

Last Name on Card

Credit Card Number

Expiration Month

Expiration Year

YYYY

CVV

Use different billing address than Parent 1?

NoYes

Billing Address

Billing City

Billing State

Billing Zip Code

THANK YOU for registering for Jewish Learning Programs at CBB!

PLEASE CLICK SUBMIT.

Gateway Fields (HIDDEN)

Gateway Address

Gateway City

Gateway State

Gateway Zip

Gateway Quantity

Gateway Amount

Gateway Amount is Tuition with Discount / Frequency unless fees are covered where it's Tuition Covered / Frequency or 0 if not credit.

Bank Details

Form Controls (CHANGE DEFAULTS TO UPDATE CONDITIONAL SECTIONS)

Enable Early Bird Discount

Early Bird EnabledEarly Bird Disabled

Subscription Start Date (Gateway)

7/05/2023+3 days

You must also update July 5 to the new year in the Auth.net connector settings. If it's possible to use date variables in calculations this could be automated in the future.

Connector Variables (UPDATE DEFAULT VALUES EACH YEAR)

Outreach Id

HIP Class Id

Hebrew Class Id

Senior Seminar Class Id

Invoice Owner User Id

User Id For Notification of Non-Member Registrations

Invoice Name / Auth.net Subscription Name

Auth.net Item Description

Authnet_Hidden_Fields

Salesforce Prefill Record Ids (HIDDEN)

Salesforce Account Id (Prefill)

Salesforce Contact 1 Id (Prefill)

Salesforce Contact 2 Id (Prefill)