HomeBASE 2023-2024 Registration - 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

* Zip

* Is there a secondary contact?

Please Select OneYes, at the same address as the primary contactYes, but at a different address than the primary contactNoIf 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)

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 OneOne ChildTwo ChildrenThree Children

* Child 1 First Name

* Child 1 Last Name

* Date of Birth

* Child 1 Primary Language

* Child 1 School Name

* Child 1 Grade in School (2023-24 school year)

* Does your child have any special learning needs?

Please Select OneYes (IEP, 504 plan, ICAP)NoMy 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 OneYesNo

Please List:

Is an Epipen required?

YesNo

* Are you a member of Temple Ohabei Shalom?

Please Select OneYes, I am a member in good standingNo, I am not a member of TOS

Please choose your schedule.

Please Select OneFull Week – Five (5) day option, M-F with pick up at 5:30pmFour (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.

Child 2 First Name

Child 2 Last Name

Date of Birth

Child 2 Primary Language

* Child 2 School Name

Child 2 grade in school (2023-24 school year)

Does your child have any special learning needs?

Please Select OneYes (IEP, 504 plan, ICAP)NoMy 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 OneYesNo

Please List:

Is an Epipen required?

YesNo

Are you a member of Temple Ohabei Shalom?

Please Select OneYes, I am a member in good standingNo, I am not a member of TOS

Please choose your schedule.

Child 3 First Name

Child 3 Last Name

Date of Birth

Child 3 Primary Language

* Child 3 School Name

Child 3 grade in school (2023-24 school year)

Does your child have any special learning needs?

Please Select OneYes (IEP, 504 plan, ICAP)NoMy 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 OneYesNo

Please List:

Is Epipen Required?

YesNo

Are you a member of Temple Ohabei Shalom?

Please Select OneYes, I am a member in good standingNo, I am not a member of TOS

Please choose your schedule.

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.