REGISTRATION FORM

September 2011– June 2012

Preschool Registration will open on:

December 20, 2010 Temple Members
432 Scotland Road, South Orange, NJ 07079 January 3, 2011 Current Students and Siblings
(973) 763-4600 cpaster@tstinj.org January 10, 2011 Open Enrollment

NAME OF CHILD__________________________ SEX _____ BIRTHDATE:

AGE OF CHILD AS OF SEPTEMBER 2011 Years____________ Months______________

PARENT NAME: BUSINESS PHONE:

PARENT NAME: BUSINESS PHONE:

ADDRESS:

E-MAIL: _____________________________________________________________________

HOME PHONE: ____________________ ARE YOU A TEMPLE MEMBER? Yes [ ] No [ ]

Please select your program below:

[ ] 3 year old: 3 day Program [ ] 3 year old: 5 day Program
M & F: 9:00 – 12:00 p.m. M,T,Th,F: 9:00 – 12:00 p.m.
W: 9:00 – 12:30 p.m. W: 9:00 – 12:30 p.m.
Child must be three by October 1, 2011* Child must be three by October 1, 2011*
Temple Member: $3,165 Temple Member $5,065
Non-Temple Member $4,125 Non-Temple Member $6,575
Deposit required: $500 Deposit required: $500
Enrichment Pricing:** Early Drop Off Options:
[ ] Monday: $525 12:00-1:30 8:00am-9:00am
[ ] Tuesday: $525 12:00-1:30 October 3rd - June 7th
[ ] Wednesday: $375 12:30-1:30 [ ] Monday’s: $165
[ ] Thursday: $525 12:00-1:30 [ ] Tuesday’s: $165
[ ] Friday: $525 12:00-1:30 [ ] Wednesday’s: $165
All year, includes lunch time. [ ] Thursday’s: $165
[ ] Friday’s: $165
[ ] Monday-Friday: $700
* Please note Kindergarten cut off in Maplewood/South Orange is October 1st.
**Please see the attached enrichment sheet for more information regarding our new program.
After selecting your choice of program, please sign this form and enclose the required deposit. This
deposit will be applied to your child’s tuition. Please make check payable to TSTI.
Mail to: Carol Paster, Iris Family Center, 432 Scotland Road, South Orange, New Jersey 07079.
 Parent Signature: Date:
Registration forms will be accepted by mail only!
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