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2020-2021 Registration/Enrollment Form for New and Returning Families
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1
Full Name of Child
*
This field is required.
Child's First Name
Child's Last Name
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2
Preferred Name (nickname)
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3
Child is Male or Female
*
This field is required.
Male
Female
N/A
Male
Female
N/A
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4
Home Address
*
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Street Address
Street Address Line 2
City
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Please Select
Please Select
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
State
Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Curaçao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
North Korea
South Korea
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
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5
Child's Birthdate
*
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-
Date
Month
Day
Year
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6
Child's T-Shirt Size
*
This field is required.
(a t-shirt will be provided in September, please order UP in size)
2T
3T
4T
5
6/7
2T
3T
4T
5
6/7
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7
Parent #1 Full Name
*
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8
Parent #1 Cell Number
*
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9
Parent #1 Email Address
*
This field is required.
example@example.com
Confirm Email
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10
Parent #2 Full Name
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11
Parent #2 Cell Number
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12
Parent #2 Email Address
*
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example@example.com
Confirm Email
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13
Parent's #1 Previous or Current Occupation
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14
Company Name and Phone Number
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15
Parent's #2 Previous or Current Occupation
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16
Company Name and Phone Number
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17
Are the parent's living together?
*
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Yes
No
Yes
No
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18
If not, with which parent does the child reside? If parents are separated, please give specific instruction concerning visiting and pick-up by the other parent.
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19
Are there any other family members living in your household (child's sibling, grandparents, etc...)
Yes
No
Yes
No
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20
Please list their names, birthdate, and relationship.
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21
Is a language other than English spoken at home?
Yes
No
Yes
No
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22
If yes, is it the primary language?
Yes
No
Yes
No
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23
What language(s)?
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24
Has anything happened in the family that might adversely affect the child's transition to school?
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25
Does your child have any food allergies or other medical conditions that we should be aware of?
*
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26
Emergency Contact #1
*
This field is required.
First Name
Last Name
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27
Phone Number
*
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28
Relationship to Child
*
This field is required.
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29
Emergency Contact #2
First Name
Last Name
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30
Phone Number
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31
Relationship to Child
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32
Child's Physician
*
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First Name
Last Name
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33
Physician's Phone Number
*
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34
Child's Previous Group Experience
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35
Does your child have complete control of urination
*
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Yes
No
Yes
No
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36
Does your child have complete control of bowels?
*
This field is required.
Yes
No
Yes
No
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37
Is the child's enunciation distinct
Yes Understandable
Dfficult to understand
Yes Understandable
Dfficult to understand
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38
Any other information that we should know or that you would like to clarify.
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39
Please select the Class(es) that you wish to register for or are interested in:
*
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NEW TODDLER & ME CLASS Monday 9:30-11:00 (March 8th-June14th)
Toddler & Me - Tues. Spring Session (THIS CLASS IS FULL!)
Toddler & Me - Thurs Spring Session (THIS CLASS IS FULL!)
2 1/2 years old class Mon/Wed (2 day)
January 2 1/2 years old class Tues/Thurs (2 day)
3 years old class Tues/Wed/Thurs (3 day)
3 years old class Mon/Tues/Wed/Thurs (4 day)
4 years old class Mon/Tues/Wed/Thurs (4 day)
4 years old class Mon/Tues/Wed/Thurs/Fri (5 day)
Discovery Friday
Lunch & Play (separate registration form handed out in May)
Enrichment Class (separate registration form handed out in May)
Other
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40
Board Positions and Volunteering
Please read through this document to answer the next question
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41
Please choose a Co-Op Board position(s) that interests you OR choose to pick two volunteer positions from a sign-up that we will email you in August, OR choose to opt out of volunteering for a$400 fee.
*
This field is required.
We are joining the Toddler & Me Class-No Board or Volunteering Position Necessary
Co-President
Secretary/Treasurer
Fundraising (2 people)
Community Engagement (2 people)
Special Events Chair (2 people)
Spring Sing Chair (2 people)
Class Parent
I will choose to volunteer for two different qualifying events during the school year. Please send me the Sign-Up Genius email document in August.
Opt Out of Committee ($400 additional cost)
Other
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42
Ridgewood Co-Op Enrollment Agreement
Please read through the entire document below.
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43
I have read the Ridgewood Co-Op Enrollment Agreement and I agree to all the requirements.
Do you agree with this statement?
YES
NO
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44
This registration is not complete until we receive the appropriate registration fee. This registration fee is non-refundable. You can pay via VenMo, by check (payable to the Ridgewood Co-Op) or by credit card. How would you like to pay?
VenMo (@ridgewoodcoop)
Mail a Check (payable to the Ridgewood Co-Op--100 Dayton Street, Ridgewood, NJ)
I already paid a registration fee for my family (Paid with another child's registration)
Bill me through Jovial (the Ridgewood Co-Op billing system where you can pay with credit card or bank transfer)
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45
Emergency Medical Authorization, Registration Fee, and Signature
In the event of a medial emergency, I authorize the staff of the Ridgewood Co-Op Nursery School to seek or provide emergency medical care for my child. I have read through the registration and enrollment agreement and I understand what is expected of me to be a part of the Ridgewood Cooperative Nursery School. I understand that this registration shall be considered upon the nonrefundable payment of the appropriate registration fee for my class.
Clear
Please sign on the line above
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46
Today's Date
*
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-
Date
Year
Month
Day
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9
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10
1
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3
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Hour
00
10
20
30
40
50
50
00
10
20
30
40
50
Minutes
AM
PM
PM
AM
PM
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47
Tags
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In Progress
Done
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