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GAN YELADIM PRESCHOOL ADMISSION FORM

 

GAN YELADIM PRESCHOOL ADMISSION FORM 2018/2019 5779

 

NAME OF CHILD___________________________________ AGE_______________

DATE OF BIRTH______________________________HOME PHONE_____________

ADDRESS_____________________________________________________________

 

PLEASE USE THE BACK OF THIS FORM TO TELL US ABOUT YOUR CHILD

 

PARENT’S NAME _____________________    PARENT’S NAME_______________________

ADDRESS_____________________________ ADDRESS_____________________________

HOME PHONE________________________    HOME PHONE__________________________

CELL_______________________________     CELL__________________________________

EMAIL ADDRESS_____________________     EMAIL ADDRESS______________________

OCCUPATION _______________________     OCCUPATION _______________________

WORK ADDRESS_____________________     WORK ADDRESS______________________

WORK PHONE _______________________    WORK PHONE ________________________

 

FIELD TRIP/EMERGENCY CARE RELEASE:

 

I GIVE MY CONSENT FOR MY CHILD TO TAKE PART IN FIELD TRIPS AND/OR EXCURSIONS UNDER PROPER SUPERVISION:   ___ YES   ___NO

 

IN THE EVENT THAT MY CHILD BECOMES ILL OR INJURED, I GIVE MY PERMISSION FOR GAN YELADIM STAFF TO SEEK EMERGENCY MEDICAL CARE: YES____ NO ____

 

______________________________________                  ____________________________

PARENT’S SIGNATURE                                                                                                      DATE

 

IF A PARENT CANNOT BE REACHED IN THE EVENT OF AN EMERGENCY, PLEASE CALL:

 

NAME____________________________ PHONE ______________ RELATIONSHIP__________

NAME ___________________________ PHONE ______________ RELATIONSHIP__________

 

NON-PARENT PICK UP:

 

I AUTHORIZE THE FOLLOWING PEOPLE TO PICK UP MY CHILD FROM GAN YELADIM:

NAME____________________________ PHONE_______________ RELATIONSHIP__________

NAME____________________________ PHONE_______________ RELATIONSHIP__________

 

MEDICAL/DENTAL INFORMATION:

 

CHILD’S PHYSICIAN ___________________________________ PHONE __________________

CHILD’S DENTIST _____________________________________ PHONE __________________

DOES YOUR CHILD HAVE ANY ALLERGIES OR TAKE DAILY MEDICATIONS? YES___ NO ___

IF YES, PLEASE EXPLAIN IN DETAIL________________________________________________

______________________________________________________________________________.

 

 PLEASE INCLUDE A DEPOSIT OF $100.00, WHICH WILL BE APPLIED TO YOUR CHILD’S FIRST MONTH OF TUITION.