NEW STUDENT APPLICATION

 

Student Information
First Name   Last Name  
Hebrew Name   Phone  
Address   Zip Code  
DOB   Place of Birth  
Previous daycare/schooling experience
School   Dates  
Choose a Program      

 

2 Day(Tue & Thurs) 3 Day (Mon. Wed. & Fri.)  5 Day
1st Choice   2nd Choice  
  Half Day
Full Day
 Extended Day
When do you want to start     
 
Family Orientation
Father's Name   Is Father Jewish  
Home Address if different   Occupation  
Business Phone   Business Address  
Cell Phone  . Email  
Mother's Name   Is Mother Jewish?  
Home Address if different   Occupation  
Business Phone   Business Address  
Cell Phone   Email  
Marital Status of Parents   If Divorced - how long?  
 
Family Synagogue Affiliation
Name of Synagogue   Name of Rabbi  
Languages Spoken at Home      
 
Siblings
Name   Age  
School      
Name   Age  
School      
 
Getting to Know Your Child
What are your child's favorite activities  
What do you perceive to be your child's strengths  
What are your child's favorite foods  
Please share with us how you discipline your child at home  
Which words do you use when complimenting your child  
Which words do you use when discipline your child  
Do you have any concerns regarding your child that you would like us to be aware of  
What are you hoping your child will gain and learn at school this year  
If you could create a perfect a school setting for your child, how would you describe it  
 
$ 75.00 Application Fee
First Name on Card   Last Name on Card  
Credit Card Type   Credit Card Number  
Exp Date   CVV  
Billing Address   Billing City  
Billing State   Billing Zip  
Phone Number    Amount