Chai Tots Preschool
Register For Summer Day Camp
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Child's Name
*
First Name
Last Name
Nickname
Hebrew Name
Gender
Age
Date of Birth
*
date of birth
Child's Home Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country
Parent or Guardian Information
Mother's Name
*
First Name
Last Name
Jewish
jewish
YES
NO
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country
Mother's Cell
*
Area Code
Phone Number
Mother's E-mail
*
E-mail
Occupation and Place of Employment
Occupation and Place of Employment
Phone Number
Phone Number
Father's Name
*
Name
Last Name
Jewish
jewish
YES
NO
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Country
Father's Cell
*
Area Code
Phone Number
Father's E-mail
*
E-Mail
Occupation and Place of Employment
Occupation and Place of Employment
Schedule
I am interested in
*
I am interested in
3 half days
3 full days
5 half days
5 full days
I need Early/Aftercare Care (Additional $15 per hour, per child)
I am interested in
Early Care (at 8am)
After Care (until 4pm)
Days of the week you prefer (if applicable)
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?
Does your child have any allergies?
Are there any medical problems that we should be aware of?
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
*
First Name
Last Name
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