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Today is:
1/7/2009

COMMUNITY HIGH SCHOOL OF JEWISH STUDIES 2008-2009 REGISTRATION FORM Complete all parts of this form or print the PDF form and send to: COMMUNITY HIGH SCHOOL OF JEWISH STUDIES 2031 THIRD AVENUE / SEATTLE, WA / 98121-2429 A SIGNED student agreement and parent consent form is required for all students. Due to liability issues, students will not be able to attend class without them.
STUDENT INFORMATION:
Last Name:
First Name:
Grad Year :
Home Address:
Home Phone:
Student Cell Phone:
Email Address:
Email is CHSJS Primary Form of Distributing Information. How often do you check your email?	Frequently Occasionally Rarely
Include my contact information in the CHSJS School Directory?	Yes No
High School:
Congregational Affiliation(s)
Youth Group(s)

PARENT INFORMATION
Parent Name:		Parent Name:
IF PARENTS AND STUDENT HAVE DIFFERENT LAST NAMES, PLEASE WRITE BOTH NAMES CLEARLY ON THIS FORM.
Work Phone:		Work Phone:
Cell Phone:		Cell Phone:
Parent Email:		Parent Email:
Billing Address: (If different than above)
Emergency Contact: (other than parents)		Phone:

STUDENT AGREEMENT:

CHSJS expects students and teachers to maintain a high level of mutual respect and to act according to Jewish values. All students who attend the school should understand and agree to the following expectations:

I will attend classes with an attitude of respect towards myself, my peers and the faculty of the school;
I understand that if I am unable to behave in an orderly and respectful manner, I will be asked to leave the class and, possibly, CHSJS altogether.
I will attend classes prepared to learn, arriving on time and maintaining regular attendance;
I will respect the rules and property of the JCC, the facility in which we are guests.
I will not leave the JCC property between or during classes without written permission from my parents and notification of the principal.

I Agree with the Student Agreement:

Yes No

COURSE REQUESTS: * Your registration will not be processed without THREE class choices for each hour.
1st Hour		2nd Hour
1st Choice:
2nd Choice:
3rd Choice:

CHSJS PARENT AGREEMENT:

Please carefully review the Tuition and Refund information. The signed agreement below states that you have read, understood, and agree to abide by its terms. I understand the expectations described above, and give permission for my child to attend the Community High School of Jewish Studies (CHSJS). I have read and understand the tuition, payment and refund information. I understand that I forfeit my tuition money if I do not abide by the refund policy. I give permission for the CHSJS to provide and/or authorize any necessary medical or dental treatment in case of an emergency. I understand that, although the school may attempt to contact me, I hereby give my permission for treatment without any further written or verbal approval from me. I release the CHSJS, the faculty and administration of the CHSJS, the boards and staff of both the Jewish Education Council and the Jewish Federation of Greater Seattle of any and all liability for any harm or injury that may occur while my child participates in the CHSJS or any program sponsored by the CHSJS. If my child drives to CHSJS, or rides with another student or parent to the CHSJS, I acknowledge that the driver, rather than the CHSJS, assumes full responsibility for events occurring in transit to or from the school, and in the parking lot of the school. I have discussed the CHSJS security policy with my child and understand that should my child leave the JCC premises during class time, CHSJS will be absolved from any accountability.

I Agree with the Parent Agreement:

Yes No

Register for one Trimester Registers for each trimester separately Full tuition due on the first day of the trimester Other payments plans may be arranged by calling the JEC
	$40 Non-refundable Registration Fee (Required fee)
	$270 x students
	$50 graduation fee (Seniors only)
	Voluntary contribution to scholarship fund.
	<< TOTAL

A tax-deductible contribution to the scholarship fund will ensure every student’s participation. Please consider it.

Tuition is Due on the First Day of each Trimester. Call 206.448.1202 to create a payment plan if you are not paying in full

Regardless of payment options selected, you may request a scholarship form:

I would like to be sent an application for a
CHSJS scholarship:

Yes No

Payment Options:

	Submit credit card information online - once you hit submit below, you will be taken to the payment page.
Please make a note of your tuition total as the balance will not be shown on the payment page. An email confirmation will be sent to your registration information.
	Print this form and enclose check for the full amount. Make check payable to CHSJS and include student’s name.
	I understand that I am responsible for any bank charges due to NSF processing
	Call in credit card information --JEC registrar (206)-448-1202

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The Jewish Federation of Greater Seattle was established 1926. Our Mission is to ensure Jewish survival and enhance the quality of Jewish life locally, in Israel and worldwide.

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