CEL Registration - East Brunswick Jewish Center

* Name of child

* Child's birthdate

* Home address

Home phone number

Name you would like your child to be called

Child's Hebrew name

* Parent 1 Name

Parent 1 Home address (if different from child)

* Parent 1 cell phone

* Parent 1 email

* Parent 2 name

Parent 2 address (if different from child)

* Parent 2 cell phone

* Parent 2 email

* Please list any allergies your child has. (If none, please wrtie none)

* Child's physician

* Physician's phone number

Child's dentist

Dentist phone number

* Please list 2 emergency contacts - name, address and phone number

* Synagogue member?

YesNo

* PARENT'S AUTHORIZATION AND PERMISSION TO PROVIDE EMERGENCY CARE: My typed name below indicates my agreement with the following: I hereby give my permission to the Center for Early Learning to call a doctor for medical or surgical care for my child should an emergency arise. It is understood that a conscientious effort will be made to locate me or my spouse before any action will be taken. If it is not possible to locate us, this expense will be accepted by us. The director or teacher are authorized to execute all documents and releases necessary to obtain such emergency medical or surgical care. The authorization shall be valid until June 30, 2023.

* INTERNAL: Photographs and video images of students in the The Center for Early Learning are routinely taken for the purpose of celebrating student achievement and sharing educational programs with the community. Photographs may be used throughout the synagogue, and/or posted on websites associated with EBJC. Video footage may also be posted on sites associated with EBJC. Please check one box below. *We are asking for permission to use students' photo/video images to be published on INTERNAL websites associated with EBJC (such as EBJC facebook page), and on EBJC publications (such as the Recorder).

I GRANT permissionI DO NOT grant permission

EXTERNAL: Photographs and video images of students in The Center for Early Learning are routinely taken for the purpose of celebrating student achievement and sharing educational programs with the community. Photographs may be submitted to area newspapers. Video footage may be submitted to area news outlets that cover special events that occur in the area or posted to websites. Please check one box below. *We are asking for permission to use any photo/video image that includes these students to be shared with EXTERNAL media outlets, including newspapers and television stations. Under no circumstances will EBJC release personally identifiable information with such images other than the child's name, age, and/or grade.

I GRANT permissionI DO NOT grant permission

* The following people are authorized to pick up my child (name and phone number)

* The following people are NOT authorized to pick up my child (name and phone number). Write N/A if not applicable

Please list your child's siblings and their ages

Has your child had group play or school experience?

Does your child have any special fears of which you are aware?

* Does your child have any developmental delays or issues of which we should be aware? Write N/A if not applicable

Has your child had any serious illnesses or surgeries? Please list and include age at time

* Does your child have any recurring mild health issues, such as colds or ear infection?

* Does your child take any medication on a daily basis? If yes, please list all medications. Write N/A if not applicable

* Registration

9:00 am - 12:30 pm9:00 am - 1:00 pm9:00 am - 3:30 pm

* Days

Monday, Wednesday, FridayMonday, Wednesday, Thursday, FridayMonday, Tuesday, Wednesday, Thursday, Friday

Please specify your needs for before/after care

* Non-refundable registration fee - $200; Returned check fee - $30

I have read and understand

* Full payments made prior to August 30, 2022 will entitle you to a 5% Discount. Also, a 5% sibling discount will be taken off the younger sibling’s tuition. There is no refund for absences, holidays, inclement weather, or any emergencies that necessitate the closing of the school or building. An enrollment conference with the director and/or classroom teacher may be required prior to the child’s first day of attendance. The Center for Early Learning reserves the right to determine whether it can accommodate the needs of each individual child and may determine that it cannot provide an appropriate setting for a particular child. In such a case, the financial responsibilities of the child’s family will be terminated as of the exit date. In the case of a special needs child, The Center for Early Learning reserves the right to require that copies of the child’s evaluation and/or the Individual Family Service Plan be forwarded to the director prior to enrollment. This information will be kept confidential by the administrative office and teachers. The Center for Early Learning reserves the right to require prompt evaluation of behavior and/or learning patterns of a child, which affect his/her school performance and adjustment. If such evaluation is required, the parent and/or guardian shall arrange, at his or her expense, for this to occur within thirty days of notification from the school. If the evaluation is not performed within this time frame the school reserves the right to terminate this agreement and the financial responsibilities of the child’s family will be terminated as of the exit date. A class may be canceled if there is not adequate registration, as determined by The Center for Early Learning by July 31, 2022. In the event that a medical emergency occurs, The Center for Early Learning is authorized to seek emergency medical care for your child as deemed necessary by the Director and/or her/his designee. Release of all information to enrolled families for use in creating class lists is solely used internally for peer communications. IN ORDER TO REGISTER, YOU MUST COMPLETE THE APPLICATION AND SEND IN A NON-REFUNDABLE REGISTRATION FEE OF $200 WITH A CHECK FOR JUNE 2022 TUITION AND 9 POST-DATED CHECKS FOR TUITION OR LEAVE A CREDIT CARD NUMBER ON FILE. YOUR REGISTRATION WILL NOT BE COMPLETE UNTIL WE HAVE ALL OF THESE ITEMS. All checks will be deposited or credit card will be charged on the first of the month. If you have may questions concerning the above, please feel free to call the office. Please note: There is NO reduction in tuition due to illness or vacation. It may be advantageous for you to prepay school tuition. For IRS rules and regulations, check with your tax advisor.

Yes - I have read and understand