PAYQUIQ ONLINE :: The Faster Smarter Way to Pay

Learning LAB (TK-12)

Experiment with Jewish life at the L.A.B where we focus on Learning, Actualizing, & Belonging. This form is for payment of fees only. To learn more about our programs or to request registration materials, please contact Karma at 209.477.9306, x302 or [email protected].

* Parent/Guardian's Name

* Are you a temple member?

	Yes
	No
	Not yet! Please contact me.

Tuition & Scholarships

Number of learners in TK-2nd Grade

Number of learners in 3rd-6th Grade

Number of 7th Graders who will attend on Wednesday (in addition to Sunday)

Number of learners in 7th & 8th Grade

Number of learners in 9th & 10th Grade

Number of 9th & 10th Graders who will attend Sababa

Number of learners in 11th & 12th Grade

* Add the fees above and enter the total tuition due for the family here:

No child will be denied an education because of financial constraints. If you would like to request a scholarship, please enter the amount requested here:

In additon to my fees, please accept my donation to the Scholarship Fund in the following amount: $

Amount you are paying today $

Account Details

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

*E-mail

*First Name

*Last Name

Payment Information

Account

Online Fee:

Credit Card

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Total:

Learning LAB (TK-12)

Tuition & Scholarships

Account Details

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

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

Learning LAB (TK-12)

Tuition & Scholarships

Account Details

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

Payment Information

Credit Card

Checking Account

For added Security please check the box below.

Image Preview