Nursery School Application 2023-2024

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2023-2024/5784

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Student Information

* Child 1 - First name:

* Child 1 - Last name:

* Name Child Is Called

* Child Gender

* Child 1 - Birthday:

* Child 1 - age on 9/1/2023:

(years/months)

Child 2 - First Name:

Child 2 - Last Name:

Name Child Is Called

Gender

Child 2 - Birthday:

Child 2 - age on 9/1/2023:

(years/months)

* Home Address

* City

* State

* Zip

* Home/Primary Phone

* Child Lives With

If "other," please specify

* Parent 1's - Full Name:

Occupation

Company

Business Address

Business Phone

* Mobile Phone

* Email Address

Parent 2's - Full Name:

Occupation

Company

Business Address

Business Phone

Mobile Phone:

Address if different from child's primary address

Is Your Child Currently Enrolled in a pre-school program?

If so, where is child enrolled

* Other Children in the Family (Names and Ages)

* Are you currently a member of Habonim

Please Select OneYesNo

If so, when did you join?

If not, how did your hear about our nursery school?

* Are you Currently a Member of Another Synagogue

Please Select OneYesNo

If so, what is the Synagogue?

What does your child enjoy?

Additional Information About Your Child

Fee Waived

A $65 non-refundable application fee must accompany this application to the Nursery School

* Parent's Signature

* Date

Sat, June 3 2023 14 Sivan 5783

Nursery School Application 2023-2024

Student Information

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