Chai Tots Preschool

  • There will be a non refundable $200 fee for registration which must be paid upon form submission.
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  • What days/hours are you interested in?

  • Any changes will be made upon the school’s discretion. Please note that there will be a fee if there will be any changes made to the schedule selected above. An additional $75 will be charged to anyone who changes their child’s schedule before the first week of school. A $150 fee will be charged after the first week of school.
  • We cannot guarantee your preferred days. Please keep in mind that we can best provide for those who are flexible.

  • I have reviewed the guidelines and I hereby register my child for the 2024-2025 school year. I also understand that once my child is accepted and contracts are signed, there are no refunds under any circumstances.
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  • Please indicate the names and telephone numbers where another authorized person(s)can be contacted in case of emergency:


  • In case of emergency, I authorize the staff to provide any medical care or first aid deemed necessary for my child. In case of an emergency in which I cannot be reached, the physician listed above and the local hospital are hereby authorized to provide any emergency care deemed necessary for my child. In case of emergency, I hereby authorize the transfer of my child’s records to the local hospital. I hereby agree to the above and give my permission to care for my child in case of emergency, including medical care or first aid; transfer of care to my child’s physician or local hospital and health records transfer.
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  • American Express
    Supported Credit Cards: American Express, Discover, MasterCard, Visa
Child's Name *
Date of Birth*
Child's Home Address*

Parent or Guardian Information

Mother's Name*
Address *
Mother's Cell *
Mother's E-mail *
Occupation and Place of Employment
Phone Number
Father's Name *
Address *
Father's Cell *
Father's E-mail*
Occupation and Place of Employment


I am interested in*
I need Early/Aftercare Care (Additional $15 per hour, per child)
Days of the week you prefer (if applicable)
Please note that there are no guarantees for day preferences. We will do our best to accommodate you.
Does your child have any allergies?
Are there any medical problems that we should be aware of?
I reviewed the guidelines and regulations and I hereby register my child for the Chai Tots Day Camp Summer of 2021. Registration fee and Day Camp Tuition are non refundable.
Signature of Parent*