CHILD ENROLLMENT FORM

Child's First Name*

Last Name*

Hebrew Name

Nickname

Birth Date*

Age in September 2025*

Gender

Address

PARENT/GUARDIAN INFORMATION

Mother's Name*

Hebrew Name

Jewish*
YesNo

Mother's E-mail*

Mother's Cell Phone*

Mother's Work Phone

Mother's Occupation and Place of Employment*

Father's Name*

Jewish*
YesNo

Father's E-mail*

Father's Cell Phone*

Father's Work Phone

Father's Occupation and Place of Employment*

How did you hear about Aleph ELC?*

Why do you want your child to attend Aleph ELC?

Days & Hours

We are currently offering 5 full days per week from 9:00am to 3:00pm.

Do you require early dropoff (Starting at 8:00 AM?)
Yes

Do you require late pickup? (Until 6:00 PM?)
Yes

PICKUP

Person authorized to pick up child*

Person who may not pick up child*

I have reviewed the guidelines and I hereby register my child for the 2025-2026 school year. I also understand that once my child is accepted and contracts are signed, there are no refunds under any circumstances.

Electronic Signature of Parent*

Date

CHILD'S INFORMATION

Does the child have any previous childcare/preschool experience?

Are there any physical disabilities or medical conditions that require accommodations or services? Please explain.

Does the child have any allergies?

Is there special food or eating instructions?

Are there any specific napping or sleeping instructions?

What are the language(s) spoken at home?

Does the child have any bowel or bladder irregularities?

Is the child right or left handed?

Is there any additional information, such as child's communication, discipline, or family circumstances that you feel we should know about?

FAMILY INFORMATION

Sibling(s) Please indicate ages and if they live with the child being registered:

Please list any other persons living with the child and their relationship to the child:

Are you affiliated with any synagogue or religious organization?
YesNoNo, but we would be interested in joining one

If yes, please specify

EMERGENCY CONTACTS

Please indicate the names and telephone numbers where another authorized person(s) can be contacted in case of emergency:

Emergency Contact #1 and Relationship

Phone Number

Emergency Contact #2 and Relationship

Phone Number

CHILD'S DOCTOR

Child's physician*

Phone*

Address

Child's Dentist

Phone

Address

EMERGENCY CARE

In case of emergency, I authorize the staff to provide any medical care or first aid deemed necessary for my child.

In case of an emergency in which I cannot be reached, the physician listed above and the local hospital are hereby authorized to provide any emergency care deemed necessary for my child.

In case of emergency, I hereby authorize the transfer of my child’s records to the local hospital.

I hereby agree to the above and give my permission to care for my child in case of emergency, including medical care or first aid; transfer of care to my child’s physician or local hospital and health records transfer.

Electronic Signature of Parent*

Date

Registration fee is $200 non-refundable deposit. Registration Fee must be paid by credit card or check.
Select your preferred payment method:

Check PaymentCredit Card Payment