Preschool Registration

Please note that registration does not confirm your spot. An email will go out with confirmation. Your credit card WILL NOT be charged without prior authorization from you after confirmation. For now the credit card you input comes in to us as an email and nothing more.

Full Name*

First NameLast Name

What would you like your child to be called?

Hebrew Name

Birth Date

MonthDayYear

Hebrew Birthday

Gender

MaleFemale

Child 1 Primary Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Child resides with:

EMERGENCY CONTACT

First NameLast Name

Emergency Contact Phone Number

Area CodePhone Number

Please check off which program you wish to enroll your child in:

Baby Room – (6 weeks-1 Years old) 8:30-3:30 – 5 Full daysBaby Room – 4 hours 8:30-12:30 (Different hours can be arranged if needed)EC 1 - (Child must be One by September 1st) 8:30- 3:30 Friday 2:20EC 2 - (Child must be 2 by September 1st) 8:30- 3:30 Friday 2:20EC 3 (Child must be 3 by September 1st) 8:30-3:30 Friday 2:20EC 4 (Child must be 4 by September 1st) 8:30-3:30 Friday 2:20

• Please note that there are certain criteria that must be met in order for your child to go into the 3 Year old class.

Does your child have any allergies or medical problems?

YesNo

Are there any conditions or behavior that require special attention, medication or a special diet?

YesNo

Has your child ever been hospitalized or had a serious illness?

YesNo

Has your child ever been evaluated for developmental delays or has an evaluation been recommended in the past?

YesNo

Additional notable InformationPlease let us know if there are any allergies or other important information we need to be aware of.

Full Name

First NameLast Name

What would you like your child to be called?

Hebrew Name

Birth Date

MonthDayYear

Hebrew Birthday

Gender

MaleFemale

Child 2 Primary Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Child resides with:

Please check off which program you wish to enroll your child in:

Baby Room – (6 weeks-1 Years old) 8:30-3:30 – 5 Full daysBaby Room – 4 hours 8:30-12:30 (Different hours can be arranged if needed)EC 1 - (Child must be One by September 1st) 8:30- 3:30 Friday 2:20EC 2 - (Child must be 2 by September 1st) 8:30- 3:30 Friday 2:20EC 3 (Child must be 3 by September 1st) 8:30-3:30 Friday 2:20EC 4 (Child must be 4 by September 1st) 8:30-3:30 Friday 2:20

• Please note that there are certain criteria that must be met in order for your child to go into the 3 Year old class.

Does your child have any allergies or medical problems?

YesNo

Are there any conditions or behavior that require special attention, medication or a special diet?

YesNo

Has your child ever been hospitalized or had a serious illness?

YesNo

Has your child ever been evaluated for developmental delays or has an evaluation been recommended in the past?

YesNo

Additional notable InformationPlease let us know if there are any allergies or other important information we need to be aware of.

Full Name

First NameLast Name

What would you like your child to be called?

Hebrew Name

Birth Date

MonthDayYear

Hebrew Birthday

Gender

MaleFemale

Child resides with:

Please check off which program you wish to enroll your child in:

Baby Room – (6 weeks-1 Years old) 8:30-3:30 – 5 Full daysBaby Room – 4 hours 8:30-12:30 (Different hours can be arranged if needed)EC 1 - (Child must be One by September 1st) 8:30- 3:30 Friday 2:20EC 2 - (Child must be 2 by September 1st) 8:30- 3:30 Friday 2:20EC 3 (Child must be 3 by September 1st) 8:30-3:30 Friday 2:20EC 4 (Child must be 4 by September 1st) 8:30-3:30 Friday 2:20

• Please note that there are certain criteria that must be met in order for your child to go into the 3 Year old class.

Does your child have any allergies or medical problems?

YesNo

Are there any conditions or behavior that require special attention, medication or a special diet?

YesNo

Has your child ever been hospitalized or had a serious illness?

YesNo

Has your child ever been evaluated for developmental delays or has an evaluation been recommended in the past?

YesNo

Additional notable InformationPlease let us know if there are any allergies or other important information we need to be aware of.

Father's Name*

First NameLast Name

Father's Cell*

Area CodePhone Number

Father's E-mail

Mother's Name*

First NameLast Name

Mother's Hebrew Name

Mother's Cell*

Area CodePhone Number

Mother's E-mail

Registration Process & Policies
• This registration form must be completed and signed for each student. The non –refundable registration fee must accompany this form in order to secure placement. • School registrants must be in good standing financially with the Emery & Mimi Green Chabad Preschool.
• Students whose tuition is in arrears will not be permitted to return to school until your account is made current. The Chabad Preschool reserves the right to cancel the enrollment of any student for non-payment. A $35 fee will be assessed for returned checks.
• Upon receipt of this registration form, a space is reserved for your child. You should also have received a packet of all necessary required forms. Children will be admitted into class when we have received all required forms and your child’s file is complete and current, pursuant to DCF & NAEYC regulations.
• The Chabad Preschool reserves the right to cancel students’ enrollment or dismiss any student/family whose conduct, influence and/or behavior is deemed unsatisfactory and not in the best interest of the school or Synagogue.
• Once month’s written advance notice is required to withdraw a child from the program without financial penalty.
• There is no tuition adjustments or credit given for holidays, family vacations or illness.
• Children are placed in classes at the discretion of the school

Signiture*

Signature

Person (s) Responsible for billing:

Student Registration Fee: $300.00 (Due upon registration)

Security Fee- $500 per child (due upon registration)

INFANT ROOM - $11000 Five full Days 8:30 am-3:20 pm (Friday 2:20 pm) , $7500 half day

YOUNG TODDLERS - $10700 Five full Days 8:30 am-3:20 pm (Friday 2:20 pm)

EARLY CHILDHOOD 2 - $ 10700 Five full Days 8:30 am-3:20 pm (Friday 2:20 pm)

Early Childhood 3 - $ 10700 Five full Days 8:30 am-3:20 pm (Friday 2:20 pm)

Early Childhood 4 $8700 withVPK $10,700 withoutVPK Five full Days 8:30 am-3:20 pm (Friday 2:30 pm)

Pre –care & After –care

Pre Care - 8:00-8:30 AM $10 per day after Care- 3:30- 5:00 pm $10 per day

NO AFTERCARE ON FRIDAY

Registration & Security Fee*

1 Child2 Children3 Children

I hereby authorize the Emery & Mimi Green Chabad Preschool to charge my credit card on the first day of each month. If the first day of the month falls on a non-business day, the card will be debited on the last day prior to the 1rst. I understand that it is my responsibility to notify the Chabad Preschool when/if the card is no longer valid and to provide a different form of payment.

Total

$0.00

Payment*

Credit Card Check

Postal / Zip Code

Country

I will turn in to the Chabad Preschool postdated checks with my tuition agreement for the amount of anticipated months my child will be enrolled.

The Emery & Mimi Green Chabad Preschool is open Monday through Friday. Our program hours are from 8:30 am to 3:30 p.m. with extended care offered from 8:00 a.m. until 5:00 pm. Please be prompt. At the end of the month, a $10 an hour late fee will automatically be charged for arrival after your designated pick up time.

I agree*

Yes

I understand and approve the use of the Alternate Nutrition plan. I agree to provide the following meals and/or snacks to meet my child’s nutritional and dietary needs. Parent: Breakfast Parent: AM Snack Parent: Noon Meal Parent: PM Snack

I agree*

Yes

Discipline at The Emery & Mimi Green Chabad Preschool will take the form of positive classroom management. Emphasis is placed on the behavior and not the individual child. Our goal is for the child to learn self-management skills and inner control - participation in a safe, loving and well planned environment. Children are provided with consistent routines and realistic limits and expectations. Children shall not be subjected to discipline which is severe, humiliating or frightening. Discipline shall not be associated with food, rest or toileting. Spanking or any form of physical punishment is prohibited. The The Emery & Mimi Green Chabad Preschool will do our best to provide proper placement of each child. Unfortunately, there are sometimes reasons we have to expel a child from our program either on a short term or permanent basis. This can be as a result of physically harmful behaviors or the like. Prior to expulsion, a parent will be called and correspondence will be sent home indicating what the problem is, and every effort will be made by both the center and the parent to correct the problem. (To see more, read the Parent's Handbook.)

I agree*

Yes

View KNOW YOUR CHILD CARE FACILITY

I agree*

I have received a copy of KNOW YOUR CHILD CARE FACILITY

I agree*

I hereby give The Emery & Mimi Green Chabad Preschool permission to photograph and videotape my child during the school year.

I agree*

I give permission for our name and telephone number to be placed on a class list for release to other parents.

My child may participate in birthday parties, holiday programs, and any other activities/ programming in which special food is served from outside or prepared in school.

I understand*

Yes

Your child will partake in indoor and outdoor physical activity during the course of the day. The children enjoy obstacle courses, balancing equipment, ball play, bicycles and the play structure for at least 40 minutes per day for half day students and 40 minutes twice daily for full day students. Please send your child to school with appropriate clothing for the weather, such as sweaters or rain gear. Children are to wear closed toe, supportive shoes. No flip flops or open back shoes allowed. When we experience inclement weather, we will partake in indoor gross motor play in our multi purpose room. Children will be encouraged, but never forced, to participate in the physical activities

I understand*

Yes

View Parent Handbook

I agree*

I have read the Parent Handbook. I understand and agree to all its content.

The following forms need to be submitted to finalize your enrollment. Forms should be emailed to [email protected] . Your child will be fully registered and a spot will be secured only when all documents and tuition contract have been received and approved by our office. Tuition contracts will be emailed to you after registration is submitted.

Influenza Form
Copy of Child's Birth Certificate
School Medical Forms (your FLORIDA pediatrician will provide these)
School Immunization Forms (your FLORIDA pediatrician will provide these
VPK Eligibility Certificate this is mandatory for all children turning 4 before September 1, 2021
Safe Sleep Policy for Infant class only
Distracted Adult
Covid-19 Waiver
Emergency Contact

I agree*

I hereby grant permission for the staff of this facility to have access to my child's records

I have read the above information and I understand and consent to all the aforementioned.
Parent’s Signature*

Comments/Notes

Preschool Registration

CHILD 1

CHILD 2

CHILD 3

PARENTS INFORMATION

PAYMENT

HOURS OF OPERATION

ALTERNATIVE NUTRITION

DISCIPLINE POLICY

KNOW YOUR CHILD CARE FACILITY

PERMISSION TO PHOTOGRAPH

PHONE LIST

OUTSIDE FOOD POLICY

PHYSICAL ACTIVITY

PARENT HANDBOOK

REQUIRED FORMS