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Mitzvah Secular Sunday School - Enrollment Form

Referral Information

Student Information

Please complete the below form for each student enrolling, as well as three emergency contacts for them.
Please make sure to include: Severity, type of reaction, methods of exposure to avoid (ex: inhaled, ingested, physical contact), and any medications they are taking to prevent/treat the allergy(s).
Please specify if each medication is taken at home or carried with them.

Emergency Contacts

Primary Emergency Contact
It is strongly recommended that this be the student's legal guardian.
Emergency Contact #2
Emergency Contact #3

Tuition Information

This information is used to calculate the total tuition for which you will be invoiced.

No household turned away: SJC does not turn away students who are unable to pay the full tuition amount. If you need to request a payment plan, lower rate, or even a full waiver, for tuition because of temporary hardship, please enroll anyway and connect with our Treasurer to explain your situation/needs so we can adjust your invoice.

Tuition Rates

$1,195 per student enrolled in:
> Kitah Gimel (6th & 7th grade)
> B Mitzvah Program
$995 per student enrolled in:
> Kitah Gan (K & 1st grade)
> Kitah Alef (2nd & 3rd grade)
> Kitah Bet (4th & 5th grade)
$495 per student enrolled in:
> Kitah Keff (Pre-K)
Give the gift of community: Any additional funds paid beyond the tuition total will be used to cover the tuitions of members whose households cannot afford the full amount due to hardship, but wish to enroll/remain enrolled.
This let's us know to keep an eye out for a check from your employer.

Consents

I/We give permission for my/our child(ren) to receive basic first aid while attending Mitzvah Secular Sunday School. I/We have informed Mitzvah Secular Sunday School staff of all my/our child(ren)'s known medical conditions and medications. I/We consent to emergency medical treatment being provided to my/our child(ren) by a licensed emergency medical team (including transport by ambulance or other emergency vehicle) when I/we cannot be reached and it is deemed immediately necessary by Mitzvah Secular Sunday School staff.
I/We give permission for my/our child(ren) to attend Mitzvah Secular Sunday School field trips, and understand that transport may be provided via private vehicles (of staff, parents of existing students, or chaperones), public transit (metro bus, streetcar or light rail) or walking. Parents will always receive at least two weeks advance notice of field trips.
I/We authorize Mitzvah Secular Sunday School to take and store photographs or video of my child(ren) while enrolled for use on the Secular Jewish Circle of Puget Sound official website and/or marketing materials.

Attestations

Tue, 14 January 2025