ShalomBASE 2024-2025 Registration - Form

ShalomBASE provides a joyful Jewish home away from home that nurtures each child’s social, emotional, and spiritual growth. Our inclusive community experience will be impactful and joyful for children while meeting the essential needs of parents.Questions? Email ShalomBASE@ohabei.org.

Section A: Family Contact Information

* Parent/Guardian First Name (Primary)

* Parent/Guardian 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 parent/guardian?

Please Select OneYes, at the same address as the primary contactYes, but at a different address than the primary contactNoIf there is a secondary parent/guardian, all emails and mailings will go to both contacts. In case of urgent need, the primary contact will be notified first.

Parent/Guardian First Name (Secondary)

Parent/Guardian 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

ShalomBASE follows the Brookline Public Schools calendar.

Registration
Families can register for five (5) days a week, four (4) days a week, or three (3) days a week. We will need a minimum of six (6) children registered to run the program.

A non-refundable deposit equal to two months’ tuition for each child is due by June 1, 2024. One month’s tuition (September 2024) will be billed upon enrollment and required to secure your child’s spot. The remainder of the deposit (June 2025 tuition) will be billed on May 15, 2024, and due no later than June 1, 2024. Deposit payments are completely nonrefundable.

Please note: if we are unable to run the program due to low registration, all deposit payments will be refunded.

* 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 (2024-25 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 Program 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.

Please Select OneFive (5) day option - M-FFour (4) day option – Choose your daysThree (3) day option – Choose your days

Please choose your schedule.

Please Select OneFive (5) day option - M-FFour (4) day option – Choose your daysThree (3) day option – Choose your days

Child 2 First Name

Child 2 Last Name

Date of Birth

Child 2 Primary Language

Child 2 School Name

Child 2 grade in school (2024-25 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 Program 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.

Please Select OneFive (5) day option - M-FFour (4) day option – Choose your daysThree (3) day option – Choose your days

Please choose your schedule.

Please Select OneFive (5) day option - M-FFour (4) day option – Choose your daysThree (3) day option – Choose your days

Child 3 First Name

Child 3 Last Name

Date of Birth

Child 3 Primary Language

Child 3 School Name

Child 3 grade in school (2024-25 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 Program 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.

Please Select OneFive (5) day option, M-FFour (4) day option - Choose your daysThree (3) day option - Choose your days

Please choose your schedule.

Please Select OneFive (5) day option, M-FFour (4) day option – Choose your daysThree (3) day option - Choose your days

Section C: Financial Information

Financial

A nonrefundable initial deposit equal to one month's tuition (September 2024) for each child is due upon enrollment. Payments can be made through this form or via check (made payable to Temple Ohabei Shalom). Email shalombase@ohabei.org if you would like to pay by check.

To complete your nonrefundable deposit, an additional month's tuition (last month payment) will be due on June 1, 2024. The remainder of the deposit (June 2025 tuition) will be billed on May 15, 2024, and due no later than June 1, 2024. Deposit payments are completely nonrefundable.

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 by 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, 2025, 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, 2025 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 ShalomBASE is closed because of weather or governmental orders related to public safety.

All-inclusive tuition includes transportation (chaperoned walk) from Lawrence and Florida Ruffin Ridley. If your child attends a different school, please reach out to the ShalomBASE team to discuss transportation options.

* I agree to the financial policy above.

I agree to the financial policy above.

Section D: Payment

Total Amount

Section E: Non-Discrimination Statement

ShalomBASE 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.