Jewish Little Star - Application

To apply for Free 3K for all for Congregation Oorah, go to NYC MySchools

Parents Information

Father

Title

Name

Hebrew Name

Occupation

Name of Employer

Work Address

Work Phone Number

Home Phone Number

Cell Phone Number

Email Address

Mother

Title

Name

Hebrew Name

Occupation

Name of Employer

Work Address

Work Phone Number

Home Phone Number

Cell Phone Number

Email Address

Family Info

Siblings

Sibling 1

Date of Birth

School

Sibling 2

Date of Birth

School

Sibling 3

Date of Birth

School

Paternal Grandparents

Grandfather First Name

Grandfather Last Name

Grandmother First Name

Grandmother Last Name

Telephone

Address

City

State

Zip Code

Maternal Grandparents

Grandfather First Name

Grandfather Last Name

Grandmother First Name

Grandmother Last Name

Telephone

Address

City

State

Zip Code

Tell us about your child

Grade applying for:

Please indicate likes, dislikes, skills and talents etc.

Previous pre-school(s) your child attended

Therapies/Interventions your child requires

Health Information

Are there any physical, medical or other problems that the preschool should be aware of?

Does your child have any allergies? Yes No

If yes, please list

Is your child currently taking any medication?

Yes No

If yes, please list

Name of child's physician

Phone number

Immunization

The Department of Health requires that we have a photocopy of your child's most recent immunization record in our files which we will require before your child can begin school. If you do not have the records, they can be obtained from your pediatrician.

Emergency Contact #1

Relationship

Phone Number

Emergency Contact #2

Relationship

Phone Number

I give consent for any necessary medical care for my child while he/she is in Little Star's custody and I cannot be reached. If my child becomes seriously ill or injured, the emergency ambulance service (911) will be called to the center, and the emergency paramedic attendant will decide whether to transport my child to the nearest hospital.

Parent Signature

Fees and Tuition

Registration fee:

Pre-Nursery (2 year old class) and Kindergarten (5 year old class)- $200
Pre-Kindergarten/UPK (4 year old class)- $35
Nursery/3K (3 year old class)- free

Registration is not complete without the registration fee listed above. This fee is non-refundable.
To ensure your child’s spot in the program, a non-refundable deposit must be paid upon acceptance.

Name on Card

Card Number

Expiration Date

CVV

Save card to charge tuition

Tuition:
Pre-Nursery (2 year old class)- $4,200 per year
Pre-Kindergarten/UPK (4 year olds) is FREE (tuition is only for Judaic Studies at $450 per year)
Kindergarten - Call about special pricing

Tuition payment is due on the first of every month

Please select for future payments. (Checks Payable to Congregation Oorah)

I will send in 10 post dated checks each dated the 1st of each month.

I will send in a check to cover the yearly tuition cost.

Please charge my credit card at the 1st of each month

Please charge my credit card on September 1st for the yearly tuition cost

By submitting this form, you agree to get communications on the contact info you provided above.

Student Information

Parents Information

Father

Mother

Family Status

Status of Student

Status of Student's Father

Status of Student's Mother

Synagogue Affiliation

Family Info

Siblings

Paternal Grandparents

Maternal Grandparents

Tell us about your child

Health Information

Immunization

Fees and Tuition