2014-2015 GAN YELADIM AT CONGREGATION BNAI ISRAEL

171 Ridge Road, Rumson, NJ 07760

732-842-1800ext.209
suzanne.ganyeladim@cbirumson.org
PLEASE PRINT ALL INFORMATION CLEARLY. PLEASE SUBMIT $50 REGISTRATION FEE
AND FIRST PAYMENT WITH APPLICATION-ONE APPLICATION PER CHILD.
APPLICATION DATE: ___________________

ENROLLMENT DATE: _____________

CHILDS NAME: ____________________________________________________________

MOTHERS NAME _______________________ CELL PHONE________________________
FATHERS NAME ________________________ CELL PHONE________________________
ADDRESS: _________________________________________________________________
HOME PHONE: _________________________ E-MAIL:_____________________________
SEX: _______D.O.B.________AGE AS OF SEPTEMBER 1, 2014:______YRS. ______MOS.
MEMBER OF CBI?

____YES ____NO

EMERGENCY CONTACTS:
1)___________________________________PHONE#:_____________________________
2)___________________________________PHONE#:_____________________________

ALLERGIES: _______________________________MEDICATIONS:_____________________
PHYSICIANS NAME: ___________________PHYSICIANS PHONE: ____________________

EARLY CHILDHOOD PROGRAMS: Please circle program choice(s):

2- YEAR OLDS (2 by 10/15/2014) 9:00-12:30 (through lunch)
2 DAYS (T/Th)
$3975.00

3 DAYS (T/Th/ F)
$4555.00

3 YEAR OLDS (3 by 10/15/2014)

# Days
3 Days
4 Days

9:00-12:00
$4555.00
$5225.00

9:00-2:00
$6045.00
$7135.00

4 YEAR OLDS (4 BY 10/15/2014)

# DAYS
3 Days
4 Days
5 Days

9:00-12:00
$4555.00
$5225.00
$5695.00

9:00-2:00
$6045.00
$7135.00
$7875.00

SHABBAT EXPERIENCE (For Pre-K aged children)

FRIDAYS

12:00-2:45pm
$775.00
KINDERGARTEN ENRICHMENT (Registered in Kindergarten)
#DAYS
5 Days

11:45-2:00
$3250.00

Ima and Me (12 months-24 months by 10/15/2014) Wednesdays 9:00-10:15

$550.00 ($250 deposit with application; remaining $275 due on December 1st)

$50.00 non-refundable registration fee waived for CBI members (excludes Ima & Me and Shabbat).
10% discount on total tuition for CBI members (excludes Ima and Me and Shabbat).
10% sibling discount on lowest total tuition (excludes Ima & Me).
5% discount on total tuition if paid in full by September 1, 2014(excludes Ima and Me and Shabbat).
st
o All tuition (except Ima & Me) to be paid in 8 equal payments. Registration fee and 1
payment must accompany application. Balance to be paid in 7 payments billed September
2014through March 2015.
st
o Ima & Me to be paid in 2 payments upon registration & Dec. 1 .
Payment Plans: Circle one and provide information to complete registration

CHECK (payable to CBI)

VISA M/C

AMEX

CASH

st

CHARGE - Check one: ___ 1 Payment Only

___All payments when due

ACCOUNT #: ____________________________________________EXP. DATE:_______

I GIVE PERMISSION FOR MY CHILD TO PARTICIPATE IN ALL SCHOOL ACTIVITIES.

I GIVE PERMISIION FOR MY CHILD TO BE PHOTOGRAPHED IN THE COURSE OF ACTIVITIES
AT GAN YELADIM WITH THE UNDERSTANDING THAT THESE PHOTOGRAPHS MAY BE USED
FOR PROMOTIONAL AND ADVERTISING PURPOSES.
I HAVE READ AND AGREE TO THE TERMS OUTLINED ON BOTH SIDES OF THIS APPLICATION.

___________________________________________
AUTHORIZED SIGNATURE

_______________________
DATE