Kiddie Korner 2021 Camp Registration

 A $100 registration fee via PayPal required. You will be directed there upon completion of this form. Please call (718) 596-4840 x 10 for assistance.

 

Child's Name*:

Child's Hebrew Name: (If inapplicable type "N/A")

DOB (MM/DD/YYYY format)*:

Gender:

Home Address*:

ZIP*:

Home Phone*:

Cell Phone:

Child Lives With*:

Child's Age by September 2021: Years Months


Father's Name*:

Father's Hebrew Name: (If inapplicable type "N/A")

Home Address (If Different From Above):

Cell Phone*:

Occupation:

Position/Title:

Work Phone:

Work/Business Address:

Email*:


Mother's Name*:

Mother's Hebrew Name: (If inapplicable type "N/A")

Home Address (If Different From Above):

Cell Phone*:

Occupation:

Position/Title:

Work Phone:

Work/Business Address:

Email*:


Previous/Current School or Playgroup*:

May we have permission to contact them?

Contact Number*:

Language/s Spoken At Home:

Language/s Spoken By Child:

Name/s, Birthday/s, and School/s of Sibling/s:

Type Special Considerations, If Any:

How Did You Hear About Kiddie Korner Day Camp?


 Please Select Which Session/s: click here for price schedule

June 28 - July 9 (2 week session)

July 12 - July 23 (2 week session)

July 26- August 13 (3 week session)

All 3 sessions 

Please Select Which Program: 

Note: We do not offer the half day program (9am - 12pm) option for children that are 4 or 5 years old, due to their schedules including special trips and programs. 

All 5 Days (of the week)? 

If Only 3 Days, Please Specify Which (M, T, W, TH, F format)


Do you consent to allow your child to participate in supervised curricular and extracurricular activities that may include leaving the building?

I am fully aware that in case of extended closures due to COVID-19 cases, a pandemic, or any public health emergencies that may arise during summer camp or regular sessions, Kiddie Korner Preschool will not refund any tuition or deposit fees that were made prior to the school's closure. In addition, any new registrations will not be refunded, even if the child did not begin care.

By typing your name, you are signing this Form electronically. You agree your electronic signature is the legal equivalent of your manual signature on this Form. 

Signature of Parent*:  

Would you like to receive emails about our future programs in the Preschool and Synagogue?

Prior to submission, you will be directed to PayPal to pay the $100 registration fee.