1. Student Form

Registration For

Toddler Nursery Pre-Kindergarten Kindergarten

Student Name

First Name Last Name

Hebrew Name

Preferred Name

Gender

Male Female

Home Address

Parent Phone

Area Code Phone Number

Birth Date

Month Day Year

Hebrew Birthday

Pediatrician's Name

Phone Number

Area Code Phone Number

Address

Emergency Contact Name

Relationship to Child

Phone Number

Area Code Phone Number

Address

Days Attending

5 days 3 days (Monday, Wednesday, Friday - Available in Toddler & Nursery only) 2 Days (Tuesday, Thursday - Available in Toddler & Nursery only)

Length of Day

Early Arrival Group: 7:30 am-8:30 am (Available Monday through Friday) Late Afternoon Group: 4:00 pm-6:00 pm (Available Monday through Thursday)

School Previously attended

School Recommended by

Additional info/Comments:

Student Form