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Education / Nursery School | |||||||||||||||||||||
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Admissions Application place optional
photo here Nursery School at Habonim 44 West 66th Street, New York, NY 10023 Phone: 212-787-5347 ext. 16 Fax: 212-595-3542
Application for Admission
2011-2012
Child’s Name: ____________________________________________ [ ] male [ ] female
Name Child Is Called: ______________________________________
Home Address: ______________________________________________ Zip: ___________________
Home Telephone: __________________________________________
Date of Birth: ________________________
Age Child Will Be September 1, 2011: ______Years ______Months
Parent’s Name: ______________________________
Occupation: _________________________ Name of Firm: _____________________________________
Business Phone: ___________________ Cell Phone #: ___________________________
E-Mail___________________________________ Parent’s Name: ________________________________
Occupation: __________________________ Name of Firm: ___________________________________
Business Phone: ____________________ Cell Phone #: _____________________________
E-mail_________________________________ Is your child currently enrolled in a pre-school program? [ ] Yes [ ] No
If so, where? __________________________________________________
Other Children in the Family
Names and Ages: _____________________________________________________________________
Applicant Lives With: [ ] Both Parents [ ] Father [ ] Mother [ ] Other
If Other is checked, please explain: _____________________________________________________
Are you currently a member of Congregation Habonim? If so, when did you join? ____________
If not, how did you hear about our Nursery School? ______________________________________
_____________________________________________________________________________________
Are you currently a member of another synagogue? [ ] Yes [ ] No If so, where? __________________________________________________________________________
_____________________________________________________________________________________
What does your child enjoy? ___________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________ _____________________________________________________________________________________
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Any relevant information about your child’s birth (e.g. full term)?___________________________
_____________________________________________________________________________________
Development? ________________________________________________________________
General Health? ______________________________________________________________
A $60.00 non-refundable application fee must accompany this application for admission to the Nursery School. Application Deadline is December 14, 2010. Please do not send in application before September 8th, 2010
Parent’s Signature: ________________________________________ Date: _____________
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