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Home
Calendar
High Holidays
Preschool Registration 2022-23
Please verify reCaptcha before submitting the form.
*
Current Synagogue Affiliation
Please Select One
Current Etz Chaim Member
Not a Member of Etz Chaim
If not currently a member, would you like to receive information about upcoming Etz Chaim activities?
Yes
No
Family Information
*
Parent Names
*
Home Address
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code
*
Cell Phone Number
*
Additional Phone Number
*
Primary Email Address
Number and Status of Preschool Children being Enrolled
(Not including Transitions/Young 5s students)
Select One
Member - 1 child
Member - 2 children
NON-MEMBER - 1 child
NON-MEMBER - 2 children
If you are not currently a member of Congregation Etz Chaim, please choose the Non-member status.
Etz Chaim member - $75 per child registration fee
Non-member - $100 per child registration fee
Student Information and Program Selection
Enter the Number of Preschool Children being Registered (same number as above)
0
1
2
*Information for children being registered for the Transitions class should be entered in the Transitions section below
*
Child's First Name
*
Child's Last Name
Nickname
*
Birthday
*
Gender
Please Select One
Female
Male
*
Child's Shirt Size
Please Select One
2T
4T
6T
*
Age Group
Select One
14 mos - 23 mos (child must be walking in order to attend)
2 yr
3 yr
PreK
Daily Schedule
- check all that apply
7:00 am - 8:00 am
7:00 am - 8:00 am
8:00 am - 9:30 am
8:00 am - 9:30 am
9:30 am - 1:30 pm
9:30 am - 1:30 pm
1:30 pm - 5:00 pm
1:30 pm - 5:00 pm
1:30 pm - 6:00 pm
1:30 pm - 6:00 pm
*
Weekly Schedule
Please Select One
5 Day Option
4 Day Option - not available for PreK
3 Day Option - not available for PreK
2 Day Option - not available for 3 yr or PreK
Final availability of days will be determined by enrollment
Day Preferences
- check all that apply
Monday
Monday
Tuesday
Tuesday
Wednesday
Wednesday
Thursday
Thursday
Friday
Friday
*
Are you registering a child for the Transitions class?
Please Select One
No
Yes
Transitions Class (Young 5's) - Enter # of Children
$200 registration fee
Child's First Name
Child's Last Name
Child's Nickname
Birthday
Gender
Please Select One
Female
Male
Child's Shirt Size
Please Select One
6T
Small
Transitions Class Schedule
Please Select One
8:00 am - 2:00 pm
8:00 am - 5:00 pm
8:00 am - 6:00 pm
TOTAL REGISTRATION FEE DUE
Fri, July 1 2022 2 Tammuz 5782