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HomeBASE 2023-2024 Registration
Please verify reCaptcha before submitting the form.
Section A: Family Contact Information
*
Adult First Name (Primary)
*
Adult Last Name (Primary)
*
Email (Primary)
*
Phone (Primary)
*
Relationship to Child(ren)
*
Address Line 1 (Primary)
Address Line 2
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip
*
Is there a secondary contact?
Please Select One
Yes, at the same address as the primary contact
Yes, but at a different address than the primary contact
No
If there is a secondary contact, all emails and mailings will go to both contacts. In case of urgent need, the primary contact will be notified first.
Adult First Name (Secondary)
Adult Last Name (Secondary)
Email (Secondary)
Phone (Secondary)
Relationship to Child(ren)
Address Line 1 (Secondary)
Address Line 2 (Secondary)
City (Secondary)
State (Secondary)
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip (Secondary)
Section B: Enrollment Information
HomeBASE follows the Brookline Public Schools calendar.
Registration
Families can register for five (5) days a week, four (4) days a week (no Tuesday for ARS) or three (3) days a week only. Group size will be limited per DEEC policy (currently 12 children/group). As such we will need a minimum of six (6) children in each group.
In order to complete your child’s registration, a non-refundable flat rate deposit of one month's tuition is due with your application. This deposit will serve as first months (September) payment.
*
How many children are you registering?
Please Select One
One Child
Two Children
Three Children
*
Child 1 First Name
*
Child 1 Last Name
*
Date of Birth
*
Child 1 Primary Language
*
Child 1 School Name
Please Select one:
FRR- Florida Ruffin Ridley
Lawrence
Pierce
*
Child 1 Grade in School (2023-24 school year)
Please Select One
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
*
Does your child have any special learning needs?
Please Select One
Yes (IEP, 504 plan, ICAP)
No
My child does not have an IEP but needs specific learning supports
The HomeBASE Director will be in touch for further documentation before the beginning of the school year. We are required by law to have this documentation on file.
Please elaborate on the needs here:
*
Does your child have any allergies or special diets?
Please Select One
Yes
No
Please List:
Is an Epipen required?
Yes
No
*
Are you a member of Temple Ohabei Shalom?
Please Select One
Yes, I am a member in good standing
No, I am not a member of TOS
Please choose your schedule.
Please Select One
Full Week – Five (5) day option, M-F with pick up at 5:30pm
Four (4) day option – with pick up at 5:30pm and with transportation to Ansin Religious School (ARS) on Tuesdays from 3:45pm - 5:45pm if applicable. HB will NOT have to pay the ARS walking fee.
Three (3) day option – with pick up at 5:30pm and with transportation to Ansin Religious School (ARS) on Tuesdays from 3:45pm - 5:45pm if applicable. HB will NOT have to pay the ARS walking fee.
Please choose your schedule.
Please Select One
Full Week – Five (5) day option, M-F with pick up at 5:30pm
Four (4) day option – with pick up at 5:30pm and with transportation to Ansin Religious School (ARS) on Tuesdays from 3:45pm - 5:45pm if applicable. HB will NOT have to pay the ARS walking fee.
Three (3) day option – with pick up at 5:30pm and with transportation to Ansin Religious School (ARS) on Tuesdays from 3:45pm - 5:45pm if applicable. HB will NOT have to pay the ARS walking fee.
Which days will your child be attending?
Monday
Tuesday
Wednesday
Thursday
Friday
Child 2 First Name
Child 2 Last Name
Date of Birth
Child 2 Primary Language
*
Child 2 School Name
Please Select one:
FRR- Florida Ruffin Ridley
Lawrence
Pierce
Child 2 grade in school (2023-24 school year)
Please Select One
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Does your child have any special learning needs?
Please Select One
Yes (IEP, 504 plan, ICAP)
No
My child does not have an IEP but needs specific learning supports
The HomeBASE Director will be in touch for further documentation before the beginning of the school year. We are required by law to have this documentation on file.
Please briefly describe your child's needs/plan and the director will be in touch if further documentation is needed for acceptance into the program
Does your child have any allergies or special diets?
Please Select One
Yes
No
Please List:
Is an Epipen required?
Yes
No
Are you a member of Temple Ohabei Shalom?
Please Select One
Yes, I am a member in good standing
No, I am not a member of TOS
Please choose your schedule.
Please Select One
Full Week – Five (5) day option, M-F with pick up at 5:30pm
Four (4) day option – with pick up at 5:30pm and with transportation to Ansin Religious School (ARS) on Tuesdays from 3:45pm - 5:45pm if applicable. HB will NOT have to pay the ARS walking fee.
Three (3) day option – with pick up at 5:30pm and with transportation to Ansin Religious School (ARS) on Tuesdays from 3:45pm - 5:45pm if applicable. HB will NOT have to pay the ARS walking fee.
Please choose your schedule.
Please Select One
Full Week – Five (5) day option, M-F with pick up at 5:30pm
Four (4) day option – with pick up at 5:30pm and with transportation to Ansin Religious School (ARS) on Tuesdays from 3:45pm - 5:45pm if applicable. HB will NOT have to pay the ARS walking fee.
Three (3) day option – with pick up at 5:30pm and with transportation to Ansin Religious School (ARS) on Tuesdays from 3:45pm - 5:45pm if applicable. HB will NOT have to pay the ARS walking fee.
Which days will your child be attending?
Monday
Tuesday
Wednesday
Thursday
Friday
Child 3 First Name
Child 3 Last Name
Date of Birth
Child 3 Primary Language
*
Child 3 School Name
Please Select one:
FRR- Florida Ruffin Ridley
Lawrence
Pierce
Child 3 grade in school (2023-24 school year)
Please Select One
Kindergarten
First Grade
Second Grade
Third Grade
Fourth Grade
Does your child have any special learning needs?
Please Select One
Yes (IEP, 504 plan, ICAP)
No
My child does not have an IEP but needs specific learning supports
The HomeBASE Director will be in touch for further documentation before the beginning of the school year. We are required by law to have this documentation on file.
Please briefly describe your child's needs/plan and the director will be in touch if further documentation is needed for acceptance into the program
Does your child have any allergies or special diets?
Please Select One
Yes
No
Please List:
Is Epipen Required?
Yes
No
Are you a member of Temple Ohabei Shalom?
Please Select One
Yes, I am a member in good standing
No, I am not a member of TOS
Please choose your schedule.
Please Select One
Full Week – Five (5) day option, M-F with pick up at 5:30pm
Four (4) day option – with pick up at 5:30pm and with transportation to Ansin Religious School (ARS) on Tuesdays from 3:45pm - 5:45pm if applicable. HB will NOT have to pay the ARS walking fee.
Three (3) day option – with pick up at 5:30pm and with transportation to Ansin Religious School (ARS) on Tuesdays from 3:45pm - 5:45pm if applicable. HB will NOT have to pay the ARS walking fee.
Please choose your schedule.
Please Select One
Full Week – Five (5) day option, M-F with pick up at 5:30pm
Four (4) day option – with pick up at 5:30pm and with transportation to Ansin Religious School (ARS) on Tuesdays from 3:45pm - 5:45pm if applicable. HB will NOT have to pay the ARS walking fee.
Three (3) day option – with pick up at 5:30pm and with transportation to Ansin Religious School (ARS) on Tuesdays from 3:45pm - 5:45pm if applicable. HB will NOT have to pay the ARS walking fee.
Which days will your child be attending?
Monday
Tuesday
Wednesday
Thursday
Friday
Section C: Financial Information
Financial
A nonrefundable initial deposit equal to one month's tuition (first month) for each child is due upon enrollment. Payments can be made via check (made payable to Temple Ohabei Shalom) or through your ShulCloud account. An invoice will be sent to you via email. To complete your nonrefundable deposit, an additional month's tuition (last month payment) will be due on June 1, 2023.
Tuition is paid based on a ten (10) month annualized rate. We have already taken holidays, and planned vacation time into account. For ease of payment, the annualized rate is broken into 10 equal payments. Families will be invoiced monthly on the 15th of each month. Payments are due the 1st of the month.
Payments received after the 10th of each month are assessed a $25 late fee. Families are responsible for any fees associated with checks returned for insufficient funds plus a $25 handling/processing fee.
Those who choose to withdraw after the start of the school year and before March 1, 2024, must give thirty (30) days written notice to the Program Director and their tuition deposit payment will be applied to the child’s final month of attendance. Families who choose to withdraw after March 1, 2024 are required to pay for the school year in full.
Tuition adjustments or refunds will not be made if a child misses school due to illness, vacation, or otherwise, and will not be made if HomeBASE is closed because of weather or governmental orders related to public safety (except as noted in the financial policies below).
All-inclusive tuition includes transportation (chaperoned walk) from Lawrence, Pierce, or Coolidge Corner Schools (FRR).
Sibling Discount: Each additional child is entitled to 10% off total tuition up to $400.
Click
Here
for tuition pricing.
*
I agree to the financial policy above.
I agree to the financial policy above.
Section D: Payment
Total Amount
Section E: Non-Discrimination Statement
HomeBASE of Temple Ohabei Shalom is an integral part of Temple Ohabei Shalom, a nonprofit organization, and does not discriminate in providing services to children and their families or teaching staff on the basis of race, gender, age, disability, marital status, veteran status, ethnic background, religion, sexual orientation, or political beliefs.
Wed, June 7 2023 18 Sivan 5783