Gan Chabad Application Form

Child Information
Name of Child*
First Name Middle Name Last Name
Hebrew Name*
Current Age*
Date of Birth*

Month Day Year
Gender*

FemaleMale

Home Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone*

Area Code Phone Number
Father's E-mail*
Family Information
Father/Guardian's Information
Father's Name*
Prefix First Name Last Name
Father's Hebrew Name
Father's Occupation*
Father's Cell Phone*

Area Code Phone Number
Father's Work Phone*

Area Code Phone Number
Mother/Guardian's Information
Mother's Name*
Prefix First Name Last Name
Mother's Hebrew Name
Mother's Occupation*
Mother's E-mail*
Mother's Cell Phone*

Area Code Phone Number
Mother's Work Phone

Area Code Phone Number
Family History
Are both the father and mother of child Jewish?*

YesNo
Was any parent or grandparent born not Jewish?*

YesNoOption 3
Marital Status*

MarriedSingleDivorcedWidowed
Siblings Information
Name
First Name Last Name
Birth Date

Month Day Year
School
Name
First Name Last Name
Birth Date

Month Day Year
School
Do you have any other children that are preschool age?*

YesNo
Are you currently on any other wait lists at another daycare?*

YesNo
Once accepted, you agree to take yourself off of other waitlists.*

yesno
Application Details
Infant Bayit Class: Ages 12 months - 18 months

Toddler Nitzanim Class: Ages 18 months- 2.5 years old (Child must be able to walk independently to join the toddler class)

Preschool Perachim Class: Ages 2.5 years to 4 years old
Class*

InfantToddlerPreschool
Admission Dates* These dates are based on possible availability in the infant room. Note that children typically graduate from the infant program to the toddler program at approximately 18 months.

Mar 2025 - Aug. 2026May 2025 - Aug. 2026Sep 2025 - Aug. 2026Other (specify dates below)
Custom Date*
Admission Dates*

Sept 2025-August 2026
Age of Child upon admission date*
Program*

Monday-Friday 8:00am-6pm
Non Refundable Deposit* Deposit will be applied to cover tuition fees for the final months of the school year for which you have registered.

469.33
Total

$0.00

Payment

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Credit Card

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

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Comments
By submitting this form, I understand and agree to the following:

1) My child is not accepted to the school until I receive email confirmation from the Gan Chabad admin team. The registration fee and deposit fee will only be processed upon my child's acceptance to the school.

2) The registration fee and deposit fee are non refundable. The deposit will be applied to cover tuition fees for the final months of the school year for which I applied. More information regarding the deposit fee can be found in the Gan Chabad Handbook HERE. Gan Chabad reserves the right to periodically update the policies in the handbook.

3) Photos taken during school may be used for promotional or publicity purposes.
Confirmation of Agreement*

I ACCEPT
Name of Applicant*
First Name Last Name
Relationship to Child*
How did you hear about us?

Search Engine/ OnlineFacebookOutdoor SignUptown Chabad ProgramsFriends/ Family
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Child Information

Family Information

Application Details