Child's Legal Name* First Name Middle Name Last Name Child's Current Class* Gan Beis - Morah Shaina G.Gan Beis 2 - Morah MiriamGan Veis - Morah BrochiGan Gimmel 1 - Morah BailyGan Gimmel 2 - Morah Rivkah K. My Child is currently toilet trained* YesNo. I understand that Summer Program is only for children who are fully potty trained prior to the start of Summer Program. This deposit will go towards Summer Program tuition, and is non-refundable. If you receive CCS vouchers and there is a discrepancy between what you receive and Summer Program tuition, then the deposit will be applied to the discrepancy. If your child is not accepted, the deposit will be refunded. Deposit * Non-Refundable $150 Dates: June 30th - Aug 14th Hours: Monday-Thursday 9:15-4:00 Friday 9:15-2:00 For Cheder children currently in Gan Beis - Gan Gimmel. CCS Vouchers Accepted $250 deposit per child due at time of application. The deposit is non-refundable. It will be applied towards Summer Program tuition. $1750 per child for the summer - Spot reserved for all 7 weeks I understand that Cheder Summer Program must be paid in full prior to the start of Summer Program. Please contact Mrs. Meltzer at [email protected] to set up a payment plan. I understand that if I have CCS vouchers, they will be applied towards my Summer Program tuition. If there is a discrepancy between my anticipated payments and the cost of tuition, I understand that I am responsible for the difference. I understand CCS recipients are still required to pay the deposit, and the deposit is nonrefundable. In the event there is an overpayment, I understand any additional out of pocket amounts will be applied as a credit to the upcoming school year's tuition. If my CCS vouchers expire during Cheder Summer Program, I understand I am required to provide payment for the remaining weeks that are after the date of expiration. If I successfully recertify, I will receive a refund when the vouchers arrive. Total $0.00 Payment* Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2025202620272028202920302031203220332034 Expiration YearBilling Address Street Address City State / Province Postal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOther Country E-mail Submit Should be Empty: This page uses TLS encryption to keep your data secure.