The Bergen Academy of Reform Judaism
B A R J
2010-2011 (5770-5771)
Payment Plan Application
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TO THE PARENTS OR LEGAL GUARDIAN OF APPLICANT: If you’re requesting a payment plan,
please complete this form in FULL. THIS FORM MUST BE RETURNED WITH YOUR DEPOSIT OF
$400 BY June 15, 2010.* Please return your completed form with your deposit to:
BARJ, 56 Ridgewood Road, Washington Township, NJ 07676
Phone (201) 722-0750 Fax (201) 722-0444
Student’s Name: ______________________ Home Address: _______________________
______________________
Home Phone Number: __________________ Grade Level as of September 2010: _______
Name(s) of Custodial Parent/Guardian(s): (Dr., Mr., Mrs., Ms.)
Guardian 1: Name __________________________Work Phone: _______________________
E-mail:___________________________ Cell Number: ______________________
Guardian 2: Name __________________________Work Phone: _______________________
E-mail:__________________________ Cell Number: _______________________
Congregation Affiliation: __________________
Payment Plan: Please read carefully, sign and return this form by June 15, 2010. Please note that the EARLY
BIRD DISCOUNT does NOT apply to families choosing a payment plan. Your total tuition payment will be the
regular tuition fee of $825.
*Unaffiliated students must submit a deposit of $600 by June 15, 2010. Their final fee will be the regular fee of
$825 + $200 unaffiliated fee for a total of $1025.
Also, please note that a $125 late fee will be added to your bill if a payment plan is NOT finalized by
June 15. 2010 or if you fail to make payments on time. Please remember that a deposit of $400 (or $600)
is due by June 15, 2010, along with your BARJ application in order to have your child enrolled in BARJ for
the 2010-2011academic year.
Payment due by: Payment Amount
August 10, 2010 $225.00
September 9, 2010 $220.00
By signing this application, you agree to pay the full amount according to schedule. Upon receipt and approval of
this form, you will receive a copy for your records.
___________________________ ___________ ____________________________ ____________
Parent/Guardian’s Signature Date Financial Secretary’s Signature Date