CBE Kids Club 2022/23 After School Registration Trimester 2 - Form

Through CBE Kids Club, Congregation Beth Elohim is excited to offer after-school childcare options for children in kindergarten through 5th grade, with flexible enrollment options. Our experienced staff has designed a nurturing after-school program, which includes pickup from 10 local elementary schools in Park Slope.

All programs operate on a trimester basis, fall, winter, spring. The second trimester runs from Monday, December 12 to Friday, March 17.

CBE Membership Status

* Are you a member of CBE?

CBE Members receive discounted rates for After School.

Student Information

* Student First Name

* Student Last Name

* Gender

* Date of birth

* Street Address

* City

* State

* Zip

* Child's Grade

Select your child's grade as of November of 2022.

* School

Enrollment Options

* Please choose from the following enrollment options:

CBE Kids Club Registration

Enrollment Options

Please select the days and number of days your child will be attending CBE KIDS Club.

Attendance Days

Number of Days Enrolled

Select the number of days your child will be attending.

Number of Days Attending (CBE Members)

* Number of Days Attending (CBE Non-Members)

Yachad First Shift Pick-up Only

NOTE: The below price reflects the cost for the full school year. You only need to register for this option in the fall semester, it will carry over for the full school year.

* Yachad Pick-up Only

Monday-$300.00Tuesday-$300.00Wednesday-$300.00Thursday-$300.00Please choose the day(s) that you will need school pickup for first shift of Yachad.

Registration Fee and Terms

There is a nonrefundable $75 registration fee for CBE Kids Club. On completion of this form you will be asked to set up a monthly payment plan for the balance, with the first payment due on registration. You can also pay in full. All accounts must be fully paid by December 12, 2022. All prior financial obligations to CBE must be fulfilled in order to participate in the CBE Kids Club term.

A standard Department of Health Medical form, which will be issued by CBE Kids Club, must be submitted after a health examination. No child will be admitted unless this document is on file before September 1. This is a Department of Health regulation.

* I agree to pay a nonrefundable $75 registration fee for this child, and agree to the terms above.

I agree to pay a nonrefundable $75 registration fee for this child, and agree to the terms above.

Sibling Information

Have you already enrolled another child for CBE Kids Club?

* Please tell us the name of the already registered sibling.

* To receive information on sibling discounts, please confirm that you have registered, and received a confirmation email from us, for the child listed above.

Sibling Discounts:

Families are entitled to a 5% discount on each child registered AFTER the first. As you have confirmed you have already registered a child, you may use the code below for your discount. We recommend you copy and paste it.

Your discount code: SIBLING5849

Please note that all uses of sibling discount codes will be thoroughly reviewed by our staff. If we cannot confirm that a child has already been registered, we will be in touch, and will bill you for the 5%.

Your Total Cost

The total cost for this child will be automatically updated below.

Total

Pickup Information

The following person(s) are authorized to pick up my child from After School:

Pick Up Contact 1 - Name

Pick Up Contact 1 - Cell Phone

Pick Up Contact 2 - Name

Pick Up Contact 2 - Cell Phone

Pick Up Contact 3 - Name

Pick Up Contact 3 - Cell Phone

End of the day dismissal options

Parents / Guardian Information

* Parent/Guardian 1 First Name

* Parent/Guardian 1 Last Name

* Parent/Guardian 1 Email

* Parent/Guardian 1 Cell Phone

Parent/Guardian 2 First Name

Parent/Guardian 2 Last Name

Parent/Guardian 2 Email

Parent/Guardian 2 Cell Phone

Emergency Information

* Does your child have allergies?

If yes, please specify allergies and action to take

* Does your child take medication?

If yes, please specify

Emergency Contact Information

In an emergency, CBE Kids will always contact the parents first. If they cannot be reached, who would you like us to contact?

* Emergency Contact 1: Name

* Emergency Contact 1: Phone

* Emergency Contact 1: Relationship

* Emergency Contact 2: Name

* Emergency Contact 2: Phone

* Emergency Contact 2: Relationship

Emergency Treatment Release

* In case of an emergency, I do hereby give authority to CBE Kids Club and its staff to obtain necessary medical emergency treatment for my child with the understanding that every effort will be made to notify the family. I hereby authorize the doctor or the hospital to which my child may be brought (and whomever they may designate as their assistants) to perform any emergency procedures or operations, to give treatment and administer anesthetics to my child / children.

In case of an emergency, I do hereby give authority to CBE Kids Club and its staff to obtain necessary medical emergency treatment for my child with the understanding that every effort will be made to notify the family. I hereby authorize the doctor or the hospital to which my child may be brought (and whomever they may designate as their assistants) to perform any emergency procedures or operations, to give treatment and administer anesthetics to my child / children.

Learning Supports

* Does your child receive extra support for learning or behavior in school?

Transportation Release

* I give permission for CBE Kids Club to pick my child up from school and walk them to Congregation Beth Elohim.

I give permission for CBE Kids Club to pick my child up from school and walk them to Congregation Beth Elohim.

Enrichment Release

I give permission for CBE Kids to bring my child to a vendor based enrichment program (or Yachad), and pick them up upon completion to return to CBE Kids Club (if applicable).

Photo Release

I authorize my child to be photographed/filmed/recorded on school premises and during school activities and/or for the school to use such images in any school communication, electronic or printed.

How did you hear about our program?

If you marked "Other", please specify