PAYQUIQ ONLINE :: The Faster Smarter Way to Pay

* Child's name

* Birth date (month/day/year)

* School and grade as of Aug/Sept. 2020

* Address:

Student's cell phone (if applicable)

Student's email (if applicable)

Please Check All That Apply To You:

	Only interested in virtual learning first semester
	I want to be a Madrich
	I would like to join Klezmer Band

Student 2 Information (Click to Open)

Child's name

Birth date (month/day/year)

School and grade as of Aug/Sept. 2020

Student's cell phone (if applicable)

Student's email (if applicable)

Please Check All That Apply To You:

	Only interested in virtual learning first semester
	I want to be a Madrich
	I would like to join Klezmer Band

Student 3 Information (Click to Open)

Child's name

Birth date (month/day/year)

School and grade as of Aug/Sept. 2020:

Student's cell phone (if applicable)

Student's email (if applicable)

Please Check All That Apply To You:

	Only interested in virtual learning first semester
	I want to be a Madrich
	I would like to join Klezmer Band

Student 4 Information (Click to Open)

Child's name

Birth date (month/day/year)

School and grade as of Aug/Sept. 2020:

Student's cell phone (if applicable)

Student's email (if applicable)

Please Check All That Apply To You:

	Only interested in virtual learning first semester
	I want to be a Madrich
	I would like to join Klezmer Band

Student 5 Information (Click to Open)

Child's name

Birth date (month/day/year)

School and grade as of Aug/Sept. 2020:

Student's cell phone (if applicable)

Student's email (if applicable)

Please Check All That Apply To You:

	Only interested in virtual learning first semester
	I want to be a Madrich
	I would like to join Klezmer Band

Parent Contact Information (click to open)

* Parent/Guardian #1: Name

Parent/Guardian #1: Cell phone

Parent/Guardian #1: Work phone

Parent/Guardian #1: Email

Parent/Guardian #1 preferred method of contact

Landline phone
Cell phone
Work phone
Email

Parent/Guardian #2: Name

Parent/Guardian #2: Cell phone

Parent/Guardian #2: Work phone

Parent/Guardian #2: Email

Parent/Guardian #2 preferred method of contact

Cell phone
Work phone
Email

Parent's address if different from child's. Please indicate if we should use this as the mailing address.

IMPORTANT NOTE: We occasionally submit pictures of our activities for publication and/or post them on our website or Facebook pages. As a matter of policy, we DO NOT identify children by name. If you would like to opt out please check the box below.

I do NOT grant permission to publish my child on Park Synagogue's website or social media accounts

Class selection and payment (click to open)

As always, each student’s tuition includes their educational materials: textbooks, project specific materials, student supplies, family holiday boxes.

*This year’s fees acknowledge the COVID 19 crisis. If you wish to pay the full amount, you would be paying it forward by helping one of our families in need at this time.

Shoresh (Roots) 1 - 2 year olds + VIP (virtual first semester)

Free program limited to 10 students and their VIP.

PRE-K & KDG (3, 4, 5 yrs. Old)

*Primary - 1st & 2nd Grade

*1st grade Consecration fee is billed separately.

* 1st Grade Consecration Fee

*3rd - 6th grade

7th - 9th grade

10th Grade - See Confirmation tab for Registration and Tuition or contact Rabbi Marcus’ office at 216-371-2244 ext. 155, for Madrich(a) Program contact Teri@parksyn.org.

11th & 12th grade

Name(s) of teen that will participate in Madrich(a) Program (Grade 8-12)

Please be sure to fill out Madrich(a) Application and turn into school office.

Name(s) of kid that will participate in Klezmer Band (Grade 7-12)

Name(s) of child(ren) that will participate in 1st Grade Consecration

Account Details

Enter your name and e-mail address for your confirmation:

*E-mail

*First Name

*Last Name

Payment Information

Account

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

Total: