Registration Form

Registration Form

 

Child’s Name_____________________ Date of Birth__________
Child’s Hebrew Name (if applicable) _____________________________
Address_______________________________________________________________________________
Street Town Zip Home Phone___________________Cell______________Email_________________________________
Parents names:_______________________________________________
I am registering for: __3 year old program __ 4 year old program __5 year old program

Program Options:
Morning Program (9:00-12:00) Choose 2 in order of preference
____2 mornings (Tuesday/Thursday) (three year old only)
____2 mornings and Wednesday afternoon (3 year old only T/Th/ A.M.~Wednesday afternoon enrichment)
____3 mornings (Monday, Wednesday, Friday)
____4 mornings (Monday, Tuesday, Wednesday, Friday)
____5 mornings (Monday-Friday)
___ Transitional Kindergarten Monday-Friday and Wednesday afternoon

Additional Options
Early Drop Off: (7:30-8:55 am) or (8:00-8:55 am) circle one _M _ T _ W _ Th _ F _
Lunch Bunch: (12:00-1:00) M _ T _ W _ Th _ F__
Afternoon Enrichment Programs: (lunch time cost included)
Monday-Thursday (12:00-3:00) M _ T _ W _ Th__ Friday ( 2:30 ) _
Stay and Play Monday -Thursday 3:00-6:00 PM Friday 2:30-4:00PM M___T___W___TH___F___

Registration Fee $275.00 Re-enrollment registration fee

Early Bird enrollment/Re-enrollment until 1/23/17 $200.00
Checks payable to Temple Israel/memo line Hertz Nursery School Registration
Registration fee is non-refundable