TODDLER Reserve Spot
Child’s Name: ________________________________ Date of Birth: ______________________
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 Bet Shalom Yeladim? _____________________________________
Scheduling Options Expected Start Date:___________
Number of
Half Day
Member of
Bet Shalom
Half Day
Full time
Member of
Bet Shalom
Full time
Full-time Program– 2, 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.
Part Time Program – 2, 3, 4 or 5 days a week
o Monday – Friday 9:00am-1:00pm
o Please mark the days that you wish attend:
Monday___Tuesday___Wednesday___Thursday___ Friday___
o Extended care can be used with the half day program. Extended care is available
between 7:00 am and 9:00 am and 1:00pm and 4:00pm Monday through Friday.
Extended care costs $13.00 per hour.
o Please mark the days you will need extended care and indicate the hours of
extended care needed:
Monday________________ Tuesday________________ Wednesday________________
Thursday_________________ Friday________________
**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
of the month in question (For example: your child’s
schedule for September is due by July 1
and October’s schedule by August 1
). 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
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 near your child’s expected start
____ I understand the policies regarding registration and enrollment.
____ I understand if I do not complete enrollment for my child at Bet Shalom Yeladim, my
deposit is non-refundable.
PARENT SIGNATURE:____________________________________________________________
DATE: ______________________