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Registration Form

Program of Interest
Start date*

Month Day Year
Please Check the Program of Interest: Infants/Toddlers

12 month program, 8 AM - 6 PM
Please Check the Program of Interest: 2s

10 month program, 9 AM - 12 PM10 month program, 9 AM - 2:50 PM12 month program, 9 AM - 2:50 PM12 month program, 8 AM - 6 PM
Please Check the Program of Interest: 3K/UPK

8:30 AM - 3:30 PM8 AM - 6 PM (Wrap-around care)
Please Select a 3 or 5 day week*

3 Days5 Days
Select 3 Days*

MondayTuesdayWednesdayThursdayFriday
Child Information
Child's Full Name*
First Name Last Name
Hebrew Name
Date of Birth*

Month Day Year
Gender*

MaleFemale
Phone Number*
Child Resides With*

Home Address*

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

Child's Age Next September (Month/Year)*
Previous/Current School or Playgroup
May we have permission to contact them?

YesNo
Previous/Current School or Playgroup Phone Number
Parent/Guardian Information
Which parent would you prefer us to contact during school hours?*
Parent 1
Full Name*
First Name Last Name
Jewish?*

YesNo
If Jewish, Hebrew Name

Home Address (if different from child's)

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

Cellphone Number*
E-mail Address*
Occupation*

Work Address

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

Parent 2
Full Name*
First Name Last Name
Jewish?*

YesNo
If Jewish, Hebrew Name

Home Address (if different from child's)

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

Cellphone Number*
E-mail Address*
Occupation*

Work Address

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

Disclaimer
If for any reason you must pull out of our program without giving Kiddie Korner a two month notice you will lose your $1000 non-refundable deposit fee and the additional two months of tuition. Should you give Kiddie Korner proper prior notice you will receive the two months tuition only.*

I understand
Our tuition prices will be raised approximately 3% yearly*

I understand
I am aware that if my child’s enrollment will start after the 1st of the month, I will still be responsible for paying the full month of tuition. *

I understand
In case of extended closures due to a pandemic or a public health emergency that arise in school during regular sessions or summer camp, Kiddie Korner Preschool will not refund any tuition or deposit fees that were paid prior to the schools closure. In addition, any new registrations will not be refunded as well even if the child did not start care.*

I understand
Any additional changes to your child’s schedule after the first week of School will cost an additional $150 fee *

I understand
Payment Information
I am interested in becoming a family member of Congregation Bnai Avraham, "the fastest growing community in Downtown Brooklyn," and receiving 3% off tuition:

Yes
Please return this form with a copy of your child's birth certificate, and a $200 registration fee and/or $1,000 deposit fee. Make check payable to Kiddie Korner Preschool, or you may pay online by completing the following and clicking the submit button at the bottom of the page. Please note that the $1,000 deposit fee is non-refundable with no exceptions. (If you are registering for 3K or UPK, there is no payment necessary).
(New Students Only) Upload birth certificate here
$200$1000$1200

Payment

Credit Card Paypal eCheck

Postal / Zip Code

Country

Your signature and submission of this form indicates that you have read, understood, and agree with the above statements.
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Program of Interest

Child Information

Parent/Guardian Information

Disclaimer

Payment Information

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