Temple Beth David Shalom Corner Early Learning Center Application 2022-2023 - Form - Temple Beth David

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Temple Beth David Shalom Corner Early Learning Center Application 2022-2023

Please verify reCaptcha before submitting the form.

2022-2023 (School year)

Student Information

* Today's date

* Child's first name

* Last name

Nickname

* Birthday

* Child's age on first day of school

(years/months)

* Home address

* City

* Zip code

* Phone number to call first

* Primary email address

Identifying Information (required by Department of Early Education and Care regulations)

* Eye color

* Hair color

* Height

* Weight

* Primary language spoken at home

* Identifying marks

* Gender

* Skin Color

Other languages spoken at home

Family Information

* Name of Parent/Guardian 1

* Relationship to Child

Home address, if different from child's

City

State

Zip code

* Cell phone

* Email address

Type of Work

Business Name/Address

Work phone

Work hours

Name of Parent/Guardian 2

Relationship to Child

Home address, if different from child's

City

State

Zip code

* Cell phone

* Email address

Type of Work

Business Name/Address

Work phone

Work hours

Parental Marital status

Custody Agreement on File

YesNo

Members of Family

Names and Birth Dates of other children in household

Others living with family

* Synagogue Membership

Please Select OneMember of Temple Beth DavidInterested in more information about Temple Beth David membershipWe are currently members of another congregationWe are not members of a synagogue

* Is your family new to Shalom Corner or are you re-enrolling?

Please Select OneNewRe-enrollingThis child is new to Shalom Corner, but our family is not.

Program selection

Enrollment is confirmed only with written verification from the Director.

We try to accommodate all students as the schedule and program capacity allows. Five day applicants will receive priority. Schedule variations will be accommodated as space allows.

* Class

Please Select OneShemesh/Sun (age 2 by September 1st)Keshet/Rainbow (age 3 by September 1st)Alim/Leaves (age 4 by September 1st) - Must select minimum 5 half days.

* Requested Daily/Weekly Schedule

Please Select One5 days Half day (8:00-1:00)5 days Full day (8:00-5:30)3 days - Monday, Wednesday, Friday - Half day (8:00-1:00)3 days - Monday, Wednesday, Friday - Full day (8:00-5:30)2 days - Tuesday, Thursday - Half day (8:00-1:00)2 days - Tuesday, Thursday - Full day (8:00-5:30)

Please let us know if you have other scheduling requests. Placement will be based on availability of space at the discretion of the Director.

* Click to pay your non-refundable, non-transferable $50 Registration Fee. The payment screen will appear after you click "Submit" at the end of the form.

Click to pay your non-refundable, non-transferable $50 Registration Fee. The payment screen will appear after you click "Submit" at the end of the form.

* Click to pay your $500 Deposit. This deposit is non-refundable and non-transferable unless we do not offer a space to your child, in which case it will be returned. The payment screen will appear after you click "Submit" at the end of the form.

Click to pay your $500 Deposit. This deposit is non-refundable and non-transferable unless we do not offer a space to your child, in which case it will be returned. The payment screen will appear after you click "Submit" at the end of the form.An additional $1,000 deposit is due by April 1st for new students and by May 1st for re-enrolling students.

* My electronic signature below represents the commitment to paying the full year’s tuition as indicated by my program selection(s) on this application.

My electronic signature below represents the commitment to paying the full year’s tuition as indicated by my program selection(s) on this application.(Click here to view current tuition rates. Rates for 2022-2023 will be set in the spring.)

PARENT NAME

Valid for one year

Mon, March 27 2023 5 Nisan 5783

Temple Beth David

7 Clapboardtree Street

Westwood, MA 02090

781-769-5270

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