Preschool Registration

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:

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

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

*

Signature

Person (s) Responsible for billing:

Tuition

Baby Room: Full Day $7500, Half Day – $4,500, Inquire in the office for the drop off fee.

2 Year olds and 3 & 4 Year Olds - $7000 Includes Pizza on Wednesday

Registration Fee (only for 2 Year Olds & EC 3&4) - $300 per Child (This can be added to the monthly tuition)

Security Fee $500 per child for the year which needs to be paid in full at the time of registration.

After Care (Until 5pm) and before care (8:00) available upon request. $5 per day if child is picked up before 4pm and $10 per day if child is picked up after 4pm.

5% Sibling discount

Registration & Security Fee*

1 Child2 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.

I HAVE READ THE ABOVE INFORMATION AND UNDERSTAND THE EMERY & MIMI GREEN CHABAD PRESCHOOL’S POLICIES. I/WE AGREE TO ADHERE TO THEM.

Preschool Registration

Student Information

CHILD 1

CHILD 2

Parents Information

Payment

Camp Gan Israel

Mikvah

Schedule of Services

Chabad

Shandy's Playground

Neshai Chabad Of Inverrary