Midrasha Registration 2019-2020

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Welcome to Berkeley-Oakland Midrasha for the year 5780!

Please fill out this entire form. If you are not ready to commit, but would like to have your teen try Midrasha out, please go ahead and fill out this form so that we have all of the necessary health and contact information. It is our policy that every Jewish teen should have access to Midrasha, so please do not consider finances when deciding whether to register. If you would like to request financial aid, you will have a chance to do so below. If you have any questions, do not hesitate to email mark@midrasha.org or call our office (510) 843-4667.

SECTION 1 - HOUSEHOLD INFO

Primary Household Information
Parent/Guardian 1




Parent/Guardian 2





Household Address







Note: members of our sponsoring synagogues will receive a $360 discount on the cost of Midrasha participation


Second Household: Parent/Guardian Contact Information










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TEEN INFORMATION

Basic Teen Information











Health and Wellness










Choose your Program and Payment Amount

About Tuition

There is a sliding scale for tuition. The highest tier reflects the full cost of providing Midrasha programs per student. We understand that many families cannot pay the full amount and it is our policy that finances should not be a barrier to any teen participating in Midrasha to the fullest extent possible. For families who are not able to pay the full amount, tuition is subsidized by the generosity of donations. Please consider paying the maximum amount that your family can afford for this year’s tuition so that we can meet everyone’s needs. Also, please do not hesitate to request financial aid if for any reason the cost of the program would deter you.

Here are this year's standard costs
Tuition for members of our partner synagogues: $799-$999
Tuition for unaffiliated families: $1,159-$1,359
Shabatonim: $475/retreat;
or if you financially commit to all three retreats, a discounted cost is available of $400/retreat

We require that 8th and 9th grade students register for at least one retreat. From 10th-12th grade families we require a nonrefundable $100 deposit toward your first retreat. Our shabatonim are a powerful element of the Midrasha experience and often serve as the glue that binds our community together.

If you are able to support others' participation through additional tax deductible donations, please do so in the Tzedakah Section.





PLEASE NOTE: Our member synagogues partially subsidize their congregants' participation in Midrasha. An unaffiliated fee of $360 per teen is applied for families not affiliated with one of our sponsoring synagogues.

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Click the link above and to the RIGHT to enroll another Teen

Voluntary Tzedakah

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TOTAL PAYMENT DUE



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CHECK PAYMENTS

Installments

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ONLINE PAYMENTS

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Emergency information



Emergency Contact 1



Please do not use any of the parents listed above as emergency contacts.
Emergency Contact 2



Please do not use any of the parents listed above emergency contacts.

WAIVERS AND AUTHORIZATIONS

I/We hereby authorize Midrasha staff as agent for the undersigned to consent to any X-ray examination, anesthetic, medical, or surgical diagnosis or treatment and hospital care which is deemed advisable by and is to be rendered under the general or specific supervision of any physician and surgeon licensed under the provisions of the Medicine Practice Act. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. 

This authorization shall remain in effect until June 30, 2020. 

PARENT/GUARDIAN UNDERSTANDING: PERMISSION

1) I authorize my child to leave the Midrasha site for supervised field trips. I give my permission to Midrasha to use this emergency information for all classes, events, and retreats attended by my child. In the event that this information changes or that I will be out of town, I will provide the Midrasha Director with updated emergency contact information. 
2) I have instructed my child to abide by all rules of safe and respectful conduct during Midrasha class and retreat activities. I understand that failure to follow safety rules will result in my child being sent home at my expense and being excluded from future activities and I will still be liable for any unpaid tuition. 
3) At their discretion, the Midrasha Director may remove my child from any program or retreat for reasons related to health or violations of Midrasha policies and Code of Conduct. Upon request, I agree to arrange for my child to be picked up from any retreat or Midrasha program immediately. 4) Neither I nor any other representative of ours will sue, claim against, attack the property of, or prosecute any of Midrasha, its directors, officers, agents and employees, and all affiliated entities for loss of property, injury, harm, accident, illness, loss of limb or life, or other personal injury, incapacity, medical cost, expense, damage, claim, or liability, howsoever caused, and regardless of whether caused directly or indirectly by my child’s acts or any acts arising out of or in connection with their participation in Midrasha and/or the retreat program, or any activity associated with either program. 
5) I understand that if the online RSVP is not received by the published deadline, my child may not be able to attend the retreat, regardless of payment received or invoiced. 
6) I grant permission for the use of still and moving photos of the above named minor in Midrasha promotional materials, unless otherwise indicated in writing.

STUDENT UNDERSTANDING: MIDRASHA POLICIES & CODE OF CONDUCT 

NOTE: Please share this policy with your teen before submitting. A paper copy will be distributed for signature at the beginning of the school year.

1) I will attend and participate fully in Midrasha classes and retreats, unless my parent(s) expressly permit me to arrive late or depart early. During the announced class and programming hours, I will attend the class/program from beginning to end, and will remain onsite during the clearly announced breaks. 
2) I am aware that the possession or use of weapons, violence, drugs, or alcohol is forbidden. I will pay for any damages I cause at Midrasha or shabbaton sites. 
3) I agree to abide by the Teen Community Agreements and the Policies described in the Midrasha Retreat Handbook; and those rules delineated by the directors, teachers, and staff(s) of Midrasha and Midrasha retreats. I understand that violation of the Midrasha Policies and Code of Conduct may result in immediate dismissal from the program.