Enrollment Registration Form

Schedule	Early Bird (Non-Members)	Regular Rates (Non-Members)	Early Bird (Members)	Regular Rates (Members)
3 Days (9 AM – 1 PM)	$8,940	$9,190	$8,690	$8,940
3 Days (9 AM – 3 PM)	$11,020	$11,320	$10,770	$11,070
5 Days (9 AM – 1 PM)	$11,020	$11,320	$10,770	$11,070
5 Days (9 AM – 3 PM)	$12,740	$13,080	$12,490	$12,830

Extended Care Options (Yearly)

Care Type	Early Bird (Non-Members)	Regular Rates (Non-Members)	Early Bird (Members)	Regular Rates (Members)
Early Care	$1,725	$1,775	$1,650	$1,700
After Care	$2,750	$2,825	$2,675	$2,750
Early & After Care	$3,850	$3,950	$3,775	$3,875

Child Information
Name of Child*
First Name Middle Name Last Name
Hebrew Name*
Current Age*
Date of Birth*

Month Day Year
Gender*

FemaleMale

Home Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone*

Area Code Phone Number
Family Information
Father/Guardian's Information
Father's Name*
Prefix First Name Last Name
Father's Hebrew Name
Father's Occupation*
Father's E-mail*
Father's Cell Phone*

Area Code Phone Number
Father's Work Phone*

Area Code Phone Number
If guardian, relation to Child
Mother/Guardian's Information
Mother's Name*
Prefix First Name Last Name
Mother's Hebrew Name
Mother's Occupation*
Mother's E-mail*
Mother's Cell Phone*

Area Code Phone Number
Mother's Work Phone*

Area Code Phone Number
If guardian, relation to Child
Family History
Is the child's mother Jewish by birth?*

YesNoOption 3
Are there any conversions in the family?*

YesNo
Are there any adoptions in the family?*

YesNo
Marital Status*

MarriedSingleDivorcedWidowed
Siblings Information
Name
First Name Last Name
Birth Date

Month Day Year
School
Do you have any other children that are preschool age?*

YesNo
Name
First Name Last Name
Birth Date

Month Day Year
School
Are you currently on any other wait lists at another preschool?*

YesNo
Once accepted, you agree to take yourself off of other waitlists.*

yesno
Application Details
Class*

InfantToddlerPreschool
Age of Child by September 1st*
I am a member*

YesNo
Click here to become a member
Early Bird Rate (By 4/30)* Non members

3 Days, 9am - 1pm ($8,940)3 Days, 9am-3pm ($11,020)5 Days, 9am-1pm ($11,020)5 Days, 9am-3pm ($12,740)
After Care Non members

Yearly Early Care (8:00-8:45am) ($1,725)Yearly Extended Care ($2,750)Early & Extended Care ($3,850)
Early Bird Rate (By 4/30)* Members

3 Days, 9am - 1pm ($8,690)3 Days, 9am-3pm ($10,770)5 Days, 9am-1pm ($10,770)5 Days, 9am-3pm ($12,490)
After Care Members

Yearly Early Care (8:00-8:45am) ($1,650)Yearly Extended Care ($2,675)Early & Extended Care ($3,775)No Early or Extended Care ($0)
$500 security fee To be paid in two payments, $250 August 1st, $250 January 1st.
Non Refundable Deposit $150

Deposit
The total includes the $150 non refundable deposit and 5% of tuition.
Non refundable deposit of 5% off tuition, to be applied to last month tuition payment.
Total

$150.00
Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment

Credit Card eCheck Check

Postal / Zip Code

Country

Comments
By submitting this form, I understand and agree to the following:

1) My child is not accepted to the school until I receive email confirmation from the Gen Aleph Preschool admin team. The registration fee and deposit fee will only be processed upon my child's acceptance to the school.

2) The registration fee and deposit fee are non refundable. The deposit will be applied to cover tuition fees for the final months of the school year for which I applied. More information regarding the deposit fee can be found in the Gen Aleph Preschool Handbook HERE. Gen Aleph Preschool reserves the right to periodically update the policies in the handbook.

3) Photos taken during school may be used for promotional or publicity purposes.
Confirmation of Agreement*

I ACCEPT
Name of Applicant*
First Name Last Name
Relationship to Child*
How did you hear about us?

Search Engine/ OnlineFacebookOutdoor SignChabad of WestonFriends/ Family
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What We Offer

Enrollment Registration Form

Extended Care Options (Yearly)

Child Information

Family Information

Application Details

Qualified Teachers

state-of-the-art classroom

safe environment

Small Class Size

Extra Curricular

Creative Lessons