Nursery School of Habonim

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Application for Admission
2021-2022
APPLICATION FEE

Non-Refundable Application Fee

* Amount

Amount$65.00

CHILD INFORMATION

* Child First Name :

* Child Last Name :

Name Child is Called:

* Date of Birth:

Age Child Will Be September 1,2020:

Years and Months

* Gender:

* Home Address :

Address 2:

* City :

* State :

* Zip Code:

* Home Phone:

How many Parents ?

PARENT INFORMATION

Parent #1

* Parent's Name:

Occupation:

Company:

Business Phone:

Business Address :

Address 2:

City :

State:

Zip Code:

Country :

* Cell Phone:

* Email :

Parents #2

* Parent's Name :

Occupation :

Company :

Business Phone:

Business Address :

Address 2:

City :

State:

Zip Code:

Country:

* Cell Phone:

* Email :

ADDITIONAL INFORMATION

Is your child currently enrolled in a pre-school program?

If yes, where?

List all other children in the family:

Applicant Lives With:

If other, 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?

If so, where ?

What does your child enjoy?

Additional information about your child:

Thu, April 25 2024 17 Nisan 5784

Nursery School of Habonim

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