Admission application.jpg

 

STUDENT INFORMATION

First Name:      

Last Name:      

Middle Name:  

Hebrew Name: 

My child prefers to be called:

Address:

City:   State: Zip:

Phone:

Date of Birth Country of Birth

DESIRED DAYS: M T W Th F

AM PM Full Day Extended Care

PREVIOUS GROUP EXPERIENCE (playgroup, day care, etc.)

Current School/Program:

Address:                           

City:  State:  Zip: 

Phone Number:

FAMILY ORIENTATION

 

Father:
Last Name:     

First Name:     

Middle Name: 

Hebrew Name: 

Address If Different from Above

Phone:

(day)          

(evening)    

Cell Phone:

Occupation:

E-mail:         

Mother:

Name:
Last Name:     

First Name:      

Middle Name:  

Hebrew Name: 

Address If Different from Above

Phone:

(day)            

(evening)     

Cell Phone:

Occupation:

E-mail:        

Parents are:
Married Separated Divorced - How Long
 

Mother Remarried - how long

Father Remarried - how long 

If parents are divorced or separated, to whom should admissions correspondence be sent?

SIBLINGS

Name: DOB

School

Name: DOB

School

Name: DOB

School

BACKGROUND INFORMATION

1. Have there been any conversions/adoptions in the family history? YES NO
If yes, please specify:

2. Are both parents Jewish? YES NO
If no, which parent is Jewish?MomDad

3. Family Synagogue Affiliation (if any):

OTHER INFORMATION

How did you hear about the Jewish Early Learning Center?

If someone referred you, please give us their name so that we may thank them:

What languages other than English are spoken at home?

I understand that all of the above information is accurate, truthful and complete and will be kept confidential.

Name of Parent or Guardian Date

Promo Code:  

 Apply Black Friday promo

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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