Enrollment Form 2020/21 CHILD’S INFORMATION:Child's English Name First Last Hebrew Name Gender* Male Female Date of Birth: (Must be at least 18 months by 9/1/23):* MM slash DD slash YYYY Current Age:*Home Address:* Street Address City StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State Zip Home Phone # or preferred #:*Child’s Pediatrician:* Full Name Pediatrician’s Phone #:*Specify whether your child recieved or recieves any therapy services. If yes, which ones?* PARENT INFORMATION:Father’s Name:* First Last Father's Occupation* Father's Email* Father's Work Phone Number*Father's Cell Phone Number*Mother’s Name:* First Last Mother's Occupation* Mother's Email* Mother's Work Phone Number*Mother's Cell Phone Number*Marital Status: (If separated or divorced, for how long?)* Married Separated Divorced Does either parent have any special resources for skills to offer our children or teachers?* ENROLLMENT:Child enrolling for:* 2 days a week (T/Th) 3 days a week (M/W/F) 5 days a week* *Please note: We recommend that Pre-K students enroll for 5 days, in order to be prepared for Kindergarten.MY CHILD IS ENROLLING IN THE MORNING PRESCHOOL PROGRAM (8:30 AM – 1:00 PM)* Yes No My child is enrolling in the Enrichment Program (1:00-3:00 PM)* Yes No My child is enrolling in the Late Care Option (3:00-4:00 PM)* Yes No My child is enrolling in the Late Care Option (4:00-5:00 PM)* Yes No Center City Jewish Preschool is an Equal Opportunity Provider. Admissions, the provision of services, and referrals of clients are made without regard to race, color, religious creed, disability, ancestry, national origin (including limited English proiciency), age, or gender. The enrollment form must be submitted with the required deposit of $500. If your child is thereafter accepted for admission, this registration fee, which is separate from tuition fees, will secure a spot for your child. If we decline acceptance, the deposit will be returned to you. In all other circumstances, the deposit is non-refundable. PLEASE MAKE CHECKS PAYABLE TO: ‘CENTER CITY JEWISH PRESCHOOL’ 527 Lombard Street., Philadelphia, PA 19147 Please print name of Parent(s)/Guardian(s):* Full Name Please print name of Parent(s)/Guardian(s):* Full Name Please sign name of Parent(s)/Guardian(s):* Date* MM slash DD slash YYYY Please sign name of Parent(s)/Guardian(s):* Date* MM slash DD slash YYYY NameThis field is for validation purposes and should be left unchanged.