Admission Application

Address*

Parent's Information
Parent Full Name*

First Name Last Name
Parent E-mail*
Optional: Parent 2
Parent 2 Full Name

First Name Last Name
Parent 2 E-mail
Please Select Desired Program*

Toddler 5 Days - Mon-Fri Nursery 5 Days - Mon-Fri Pre-K 5 Days - Mon-Fri
Preschool Length of Day

8-9 AM Early Care 1-3 PM Extended Day Program 1-4 PM Extended Day Late Program 1-5 PM Extended Day Late Program
How did you hear about Chai Preschool?
Why is a Jewish early childhood program important to your family?
Comments
New applicants, please include a one time, non-refundable administrative fee of $75.00 to be added to waitlist.
Payment*
To pay with Card

$75

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Child's Information