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____________ PARENT NAME: PARENT NAME: ADDRESS: E-MAIL: _____________________________________________________________________ HOME PHONE: ____________________ ARE YOU A TEMPLE MEMBER? Yes [ ] No [ ] Months______________

BUSINESS PHONE: BUSINESS PHONE:

Please select your program below:

[ ] 4 year old: 5 day Program M, T, Th, F: 9:00 12:00 p.m. W: 9:00 12:30 p.m. Child must be four by October 1, 2011* Temple Member $5,065 Non-Temple Member $6,575 Deposit required: $500 Early Drop Off Options: 8:00am-9:00am October 3rd - June 7th [ ] Mondays: $165 [ ] Tuesdays: $165 [ ] Wednesdays: $165 [ ] Thursdays: $165 [ ] Fridays: $165 [ ] Monday-Friday: $700 Enrichment Pricing:** [ ] Monday: $525 12:00-1:30 [ ] Tuesday: $525 12:00-1:30 [ ] Wednesday: $375 12:30-1:30 [ ] Thursday: $525 12:00-1:30 [ ] Friday: $525 12:00-1:30 All year, includes lunch time. Enrichment Pricing: [ ] Mini Monet & Passports Tuesday/Thursday: $1,350 12:00pm-2:00pm Class alternates approximately every three months. All year, includes lunch time.

* 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 childs 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!