BETSHALOMYELADIMPRESCHOOL
INFANTENROLLMENTFORM
Child’sName:__________________________DueDate/BirthDate:______________________
Address:______________________________________________________________________
City:__________________________________________ZipCode:_______________________
HomePhone:__________________________________________________________________
Parent/LegalGuardianName:_____________________________________________________
WorkNumber:____________________________CellNumber:_________________________
EMailAddress:_________________________________________________________________
Parent/LegalGuardianName:_____________________________________________________
WorkNumber:____________________________CellNumber:_________________________
EMailAddress:_________________________________________________________________
SynagogueAffiliation:____________________________________________________________
Howdidyouhearaboutthepreschoolprogram?______________________________________
Reserve Spot
Scheduling Options
Expected Start Date: _______________________________
Full-time Program– 3, 4 or 5 days a week
o Monday-Thursday 7:00am-6:00pm
o Friday 7:00am-5:00pm
o Please mark the days you wish to attend:
Monday___Tuesday___ Wednesday___Thursday___Friday___
Your child does not need to stay for the entire day. They can arrive and depart as needed but
the full day of care will always be available to you when signing up for full-time care.
Monthly Tuition
(Full day program only)
Number of
Days
Member of
Bet Shalom
Non-Member
3
$870.00
$970.00
4
$1,160.00
$1,260.00
5
$1,425.00
$1,500.00
**If your child’s schedule will vary by week or month, please provide that schedule to the
Director two months in advance on the 1
st
of the month in question (For example: your child’s
schedule for September is due by July 1
st
and October’s schedule by August 1
st
). This assures the
best staff to child ratio. If the schedule changes within that two month window and you need
extra care, we will accommodate wherever possible based on the teacher/child ratio scheduled
at that time. Please note that two months’ notice is needed in order to decrease a child’s
schedule.
I understand that enrollment is based on availability of space in an age appropriate class.
Congregants of Bet Shalom Congregation and presently enrolled families receive priority
enrollment. A non-refundable deposit of $100 must accompany this form. This deposit will be
applied to your first month’s tuition costs. If your child is not already enrolled in Bet Shalom
Yeladim, further registration information will be distributed upon receipt of your enrollment
form.
____ I understand the policies regarding registration and enrollment.
PARENT SIGNATURE:____________________________________________________________
DATE: ______________________