Keshet Registration 2024-2025 - Form

Keshet Registration 2024-2025

* Child's Name

* Gender

* Date of Birth

Child’s Hebrew Name [if any]

* Address

* City

* Zip

* Home phone #

* Are you a member of any Rochester synagogue?

* Will this be his/her first time in a preschool program?

YesNo

If other, where?

Program Selection

* Child's age of December 1, 2024

Days per week:

2 Days a Week3 Days a Week18-24 month old children are eligible for 2 and 3 day weeks.

Days to attend:

TuesdayWednesdayThursday

Days per week:

2 Days a Week3 Days a Week5 Days a Week2-year-old children are eligible for 2, 3, and 5 day weeks.

Days per week:

3 Days a Week5 Days a Week3-year-old children are eligible for 3 and 5 day weeks.

5 Days a Week

5 Days a Week4-year-old children are eligible for a 5 day week only.

* Child's age of December 1, 2024

Days per week:

2 Days a Week3 Days a Week18-24 month old children are eligible for 2 and 3 day weeks.

Days to attend:

TuesdayWednesdayThursday

Days per week:

2 Days a Week3 Days a Week5 Days a Week2-year-old children are eligible for 2, 3, and 5 day weeks.

Days per week:

3 Days a Week5 Days a Week3-year-old children are eligible for 3 and 5 day weeks.

5 Days a Week

5 Days a Week4-year-old children are eligible for a 5 day week only.

Primary Parent Information

* Parent/Guardian Name

* Email Address

* Cell Phone #

* Work Phone #

* Home Phone #

* Occupation

* Are you Jewish?

YesNo

Home Address (if different from child)

Secondary Parent Information

Parent/Guardian Name

Email Address

Cell Phone #

Work Phone #

Home Phone #

Occupation

Are you Jewish?

YesNo

Home Address (if different from child)

* Name of Emergency contact:

* Relationship

* Phone #

* Pediatrician Name

* Phone #

* Dentist Name

* Phone #

Permission

My child, named above, has permission to attend all supervised field trips and activities of Keshet Preschool from September 2024 – June 2025. I/We understand that reasonable vigilance in the care and supervision of the children will be exercised. Beyond this I/We will not hold the school or those supervising the trip responsible.

* Signature of Parent or Guardian

* Date of Initial

I authorize the use of photographs of my child for Keshet advertising. No names will ever be used without additional parent permission.

* Signature of Parent or Guardian

* Date of Initial

I authorize the use of my child's photograph for in-house purposes only, including newsletters and emails.

* Signature of Parent or Guardian

* Date of Initial

Transportation

These are the people that you are allowing to pick up your child. Otherwise, we will need written permission to dismiss your child to anyone not noted on this list

Name and Phone Number

Alerts

Things Keshet should know about my child

Allergies and treatment:

Medications:

Accidents, illnesses or traumas:

Developmental Information

Please explain any concerns that you might have about your child’s development:

Social:

Emotional:

Physical:

Techniques for calming your child when upset:

Special interests your child has:

Other information, about your child, that you would like our staff to be sensitive to:

Pandemic Information

Please note that in the event that we need to shut down for any pandemic, you have the right to choose if your child continues with digital learning. If you do choose this option, you will be given materials for two weeks at a time, as well as access to daily virtual lessons on the days your child attends. If you do not choose to have your child continue digitally, you will not receive materials or have access to digital learning. You will receive a credit for the aomunt of time we are closed.

* This agreement is made between Temple Beth El, on behalf of Keshet Preschool, 139 Winton Road South, Rochester, NY 14610 and the undersigned parent(s) or guardian(s) of:

Parental Agreement

* We have read and understand this enrollment contract and agree that by signing below it we accept responsibility for all financial obligations contained herein.

Financial Agreement

* Persons(s) responsible for payments to Temple Beth El (please type names below, this will act as a legal signature).

Payer Agreement

* I understand that, if paying by charge card, there will be a 3% surcharge applied to offset necessary system fees. If you would like to pay by paper check, please call the office at (585)473-1770 to discuss options.

Credit Card Agreement

Please be sure to alert our staff if any issues or concerns develop throughout the year. Sometimes changes at home will affect a child’s behavior in school. This information will help us to help your child through any difficulties.
We are committed to a close partnership between home and school.

A payment plan must be set up upon confirmation with full payment due by April 30, 2025. If you do not set up a plan, one will be set up for you, recurring on the 1st of every month starting September1, 2024.