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Child Information |
Last Name
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First Name
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Hebrew Name
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Gender
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Date of Birth
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Age
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Address
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City, State, Zip
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Home Phone
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Sibling 1 Name
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Age
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Attended CIC Preschool?
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School Currently Attending
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Sibling 2 Name
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Age
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Attended CIC Preschool?
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School Currently Attending
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Parent Information |
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Mother |
Mother's Name
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Hebrew Name
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Occupation
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Firm Name
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Firm Address
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Firm Phone
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Cell
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Email Address
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Country of Origin
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Father |
Father's Name
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Hebrew Name
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Occupation
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Firm Name
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Firm Address
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Firm Phone
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Cell
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Email Address
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Country of Origin
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General Information |
Is your child currently receiving any services through EI or CPSE? YesNo If Yes, please explain:
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Is your child currently attending child care?YesNo If Yes, where?
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Is your family affiliated with a congregation? If yes, which one?
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Does the child live with both natural parents?
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Is the child's natural mother Jewish?
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Are there any adoptions in your family?
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Are there any Conversions in your family? Who?
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You may arrange to discuss these issues with our Rabbi |
School Year Applying for:
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Reference 1
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Phone Number
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Reference 2
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Phone Number
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Please select desired program |
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Preschool Length of Day |
| 5 Days - Mon-Fri |
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2's Full Day 9:00am - 3:00pm |
| 3 Days - Mon/Wed/Fri |
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2's Half Day 9:00am - 12:30pm |
| 2 Days - Tues/Thurs |
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3's Full Day 9:00am - 3:00pm |
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Optional: Early Care |
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4's Full Day 9:00am - 3:00pm |
| Early Care from 8:30am |
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How did you hear about Alef Bet Preschool?
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