Registration for current students – Chai Tots Preschool

There will be a non refundable $100 fee for registration which must be paid upon form submission.
Child's First Name*
Last Name*
Hebrew Name
Nickname
Birth Date*
MM slash DD slash YYYY
Age in September 2024*
Gender
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Home Phone
PARENT/GUARDIAN INFORMATION
Mother's Name*
Hebrew Name
Jewish*
- YES
- NO
Address*
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Mother's E-mail*
Mother's Cell Phone*
Mother's Work Phone
Mother's Occupation and Place of Employment*
Father's Name*
Jewish*
- Yes
- No
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Father's E-mail*
Father's Cell Phone*
Father's Work Phone
Father's Occupation and Place of Employment*
How did you hear about Chai Tots Preschool?*
Why do you want your child to attend Chai Tots Preschool?
What days/hours are you interested in?
I am interested in the following days/hours
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.
Are you interested in any specific days of the week, or are you flexible? Please specify.
We cannot guarantee your preferred days. Please keep in mind that we can best provide for those who are flexible.
Do you require early dropoff?
- Early dropoff
Do you require late pickup?
- Late pickup
Please check your site preference*
- Park Slope
- Windsor Terrace
- Prospect Heights
Are you flexible? Please specify.*
PICKUP
Person authorized to pick up child*
Person who may not pick up child*
I have reviewed the guidelines and I hereby register my child for the 2021-2022 school year. I also understand that once my child is accepted and contracts are signed, there are no refunds under any circumstances.
Electronic Signature of Parent*
Date
MM slash DD slash YYYY
CHILD’S INFORMATION
Does the child have any previous childcare/preschool experience?
Are there any physical disabilities or medical conditions that require accommodations or services? Please explain.*
Does the child have any allergies?*
Is there special food or eating instructions?*
Are there any specific napping or sleeping instructions?*
What words does the child use to indicate that he/she needs the toilet?
Does the child have any bowel or bladder irregularities?*
Is the child right or left handed?
Is there any additional information, such as child's communication, discipline, or family circumstances that you feel we should know about?
FAMILY INFORMATION
Sibling(s) Please indicate ages and if they live with the child being registered:
Please list any other persons livings with the child and their relationship to the child:
Are you affiliated with any synagogue or religious organization?
If yes, please specify
EMERGENCY CONTACTS
Please indicate the names and telephone numbers where another authorized person(s)can be contacted in case of emergency:
Emergency Contact #1*
Phone Number
Emergency Contact #2*
Phone Number
CHILD’S DOCTOR
Child's name*
Child's physician*
Phone*
Address
Child's Dentist
Phone
Address
EMERGENCY CARE
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.
Electronic Signature of Parent*
Date
MM slash DD slash YYYY
Registration fee is $100 non refundable deposit. Registration Fee must be paid by credit card below.
Price:
Credit Card

American Express
Discover
MasterCard
Visa
Supported Credit Cards: American Express, Discover, MasterCard, Visa
Card Number Expiration Date Security Code Cardholder Name

PARENT/GUARDIAN INFORMATION

What days/hours are you interested in?

PICKUP

CHILD’S INFORMATION

FAMILY INFORMATION

EMERGENCY CONTACTS

CHILD’S DOCTOR

EMERGENCY CARE

Parent or Guardian Information

Schedule

917-618-3953