KIDDIE KORNER PRESCHOOL Registration Form
117 REMSEN STREET
BROOKLYN, NY 11201
(718) 596-4840

**If you prefer to download a pdf version of the form and mail it in please click here to download the form.

1. Program of Interest
School Year of Entry
Please check days of interest
Monday Tuesday Wednesday Thursday Friday
Please check times of interest
9:00am - 12:00pm 9:00am - 3:00pm 8:00am - 6:00pm
What date would you like your child to begin?

2. Child Information
Last Name
First Name
Hebrew Name
Birth Date
Gender
F M		 Home Address
Zip Code
Home Phone
Cell Phone
Child resides with
Child's age next September [Years / Months]
/
Previous/Current School or Playgroup
May we have permission to contact them?
Yes No		 Phone
Please note below any special consideration regarding your child
Language(s) spoken at home
Language(s) spoken by child
How did you hear about our school?
Names, Birth Dates, Schools of Siblings:

3. Parent Information
Father
Last Name
First Name
Jewish?
Yes No
If Jewish, Hebrew Name Home Address
(if different from above) 		Zip Code
Home Phone
Work Phone
Cell Phone
E-mail Address
Occupation
Work Address
Zip Code
   
Mother
Last Name
First Name
Jewish?
Yes No
If Jewish, Hebrew Name Home Address
(if different from above) 		Zip Code
Home Phone
Work Phone
Cell
E-mail Address
Occupation
Work Address
Zip Code
   

4. Parent Consent for Activities Outside the Building
I give my child, , permission to participate in supervised curricularand extracurricular activities that may include leaving the school building and traveling by public or private transportation.
Signature
Relationship
Date

5. Parental Involvment
It is our belief that a child’s learning experience is enhanced when his/her parents are actively involved in sharing the experience. Furthermore, parental involvement in the preschool’s organization and activities helps the preschool to function at its highest level. We, therefore, encourage all parents to find ways of participating in their child’s Jewish education and offer the following opportunities for your consideration.
Would you be interested in: (please indicate which parent)
Becoming a class parent
Yes No		 If yes, which parent?
Assisting the class parent
Yes No		 If yes, which parent?
Helping with special holiday celebrations
Yes No		 If yes, which parent?
Reading or telling a story
Yes No		 If yes, which parent?
Sharing an experience or professional knowledge with a class (e.g., a baby naming, a personal tzedakah project, a trip to Israel, work-related experiences, ethical dilemmas, a Judaica collection, etc.)
Yes No		 If yes, which parent?
Helping in another way
Yes No		 If yes, which parent?
Would you be interested in taking an adult study course in:
Basic Judaism
Yes No		 If yes, which parent?  
Hebrew
Yes No		 If yes, which parent? If yes, what is your level in Hebrew?
Torah & Text study
Yes No		 If yes, which parent?  
Kabbala/Mysticism
Yes No		 If yes, which parent?  
Other
Yes No		 If yes, what specifically? and which parent?

6. Electronic Signature
NOTE: If for any reason you must pull out of our program, you will lose the deposit and an additional two months of tuition.
Signature of Parent
Date

7. Payment Information

I am interested in becoming a family member of Congregation Bnai Avraham, "the fastest growing community in downtown Brooklyn," and receive 3% off tuition?
Please return this form with a copy of your child’s birth certificate, and a $200 registration fee. Make check payable to Kiddie Korner Preschool or you may pay online by completing the following and clicking on the submit button at the bottom of the page.
Please select amount paying at this time from drop-down menu:

 

**Kiddie Korner’s website provides an area for parents to view pictures of their children’s activities. However, this area of the site can only be accessed by parents. Therefore, we have set up a log-in system in order to access the site.To obtain the username and password, please contact the Director at director@kiddiekorner.org.