Preschool Application 2021-2022

Preschool Registration Application

2021/2022

A valid credit card is required in order for your application to be processed. Without payment your application will remain on hold.

CHILD'S INFORMATION

First name *

Last name *

DOB *

Month Day Year

Languages Spoken at Home (other than English)

Preferred Contact Number *

Preferred Contact E-mail *

Additional E-mail for School Communication

Street address *

City *

State *

Zip code *

Child's Gender *

Female Male

Applying for Grade *

Daycare (3 months – 17 months) 9:00 AM -1:00 PM $7,300 Daycare (3 months – 17 months) 9:00 AM -3:00 PM $10,100 Toddler (18 months by Oct. 15th)* 9:00 AM -1:00 PM $7,300 Toddler (18 months by Oct. 15th)* 9:00 AM -3:00 PM** $10,100 Nursery (3 yrs by Oct. 15th) 9:00 AM -3:00 PM $9,850 Pre-K (4 yrs by Oct. 15th) 9:00 AM -3:00 PM $9,850 Kindergarten (5 yrs by Oct. 15th) 9:00 AM -3:00 PM $12,500

Tuition rates are subject to change.

*Classes will be arranged by age in the Toddler program.

**Includes nap time.

Early Care and Extended Care - TBD

Is your child currently enrolled at Lubavitch on the Palisades School? *

Yes No

Please list all current and previous schools and/or camps your child has attended. Please provide principal/teacher's name and phone number (NEW STUDENT QUESTIONNAIRES will be emailed to you to be filled out by your child's current teacher/director and parent. Application will be processed once the questionnaires are received) *

Do you have any concerns about your child's: *

Behavior Speech Learning Physical Development Fine Motor Skills No Concerns

Please Explain: *

Has your child ever been evaluated by early intervention, Bergen County Special Services, or a speech/occupational therapist? *

Yes No

Please provide reason for evaluation and name of the person/agency that evaluated your child. Please provide a copy of the evaluation and email to vered@LPSNJ.org, or fax to (201) 871-4181. Application will be processed after reports are received.

Has your child received or is your child currently receiving any type of intervention, occupational/speech/early intervention therapy, or long term medical treatment? *

Yes No

Please provide names and contact information of therapist/doctor/service providers:

FAMILY INFORMATION

Are both biological parents living? *

Yes No

Parents Are *

If parents are divorced, to whom should admissions correspondence be sent?

If parents are remarried, please indicate the name of the step-parent:

MOTHER/PARENT 1 - INFORMATION

Title *

Mother's Name *

Mother's Last Name *

Mother's Cell Phone *

Mother's E-mail *

Occupation

Employer

FATHER/PARENT 2 - INFORMATION

Title *

Father's Name *

Father's Last Name *

Father's Cell Phone *

Father's E-mail *

Occupation

Employer

Is the Child's Biological Mother Jewish? *

Yes No

Has the child or child’s mother had a conversion? If yes, please provide the conversion certificate.

Yes No

SIBLINGS INFORMATION

Did you have any other children who attended LPS? *

Yes No

Please list all the siblings, their dates of birth and the schools they attend:

SYNAGOGUE AFFILIATION

Name of the Synagogue, City and State

Name of the Rabbi

PARENT/GUARDIAN RECOMMENDATIONS

If your child has any special considerations, including health issues or special needs which you feel Lubavitch on the Palisades School should be aware of, please describe briefly:

How did you hear about Lubavitch on the Palisades School?

Please specify friend or family associate

Why do you feel Lubavitch on the Palisades School is the appropriate school for your child?

Emergency Contact 1 (in case any of the parents can't be reached) In the event of an emergency, please contact:

Emergency Contact Name *

Relationship

Emergency Contact Phone Number *

Is this person authorized to pick up your child? *

Yes No

People authorized to pick up your child from school (other then carpool or parents)

Child Release 1: First and Last Name

Relationship

Child Release Phone1

Child Release 2: First and Last Name

Relationship

Child Release Phone2

Field Trip Permission

I give permission for my child to participate in walking trips within the school’s neighborhood. *

Yes No

Photo Permission I hereby grant permission for photography and videography of my child’s activities at the school or any activities related to the school for public relations purposes (Facebook or newspaper). I agree that I am to receive no compensation for my child’s appearance and that this participation confers on me no ownership rights whatsoever. (Please mark yes or no)

Photo Release *

Yes No

Carpool Info Sharing
Would you like us to share your contact information with parents from your area who are looking for a carpool?

Share info: *

Yes No

MEDICAL INFORMATION

Please list any of the following: Current medications, medication allergies, food allergies, or chronic health concerns. If none, please write N/A. (More detailed medical forms will be sent out later and due back in the Spring) *

CLASS PLACEMENT

Please include any information that you would like us to take into consideration when placing your child. If none, please write N/A. *

Preschool Registration Fee - $770 per application ($990 After Jan 1st, 2021)
Daycare Registration Fee - $360 per application

The application fee is non-refundable and doesn't get applied towards the cost of tuition.

Security Fee - $400 per child
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Sibling Discount - $360 offer off one child
Twin Discount - $500 offer off one child
NO Building Fund

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By submitting this form, I attest that the above information is correct. I consent to have to the school Directors contact my child's previous schools and any professionals that worked with my child and I am aware that class placement is at the discretion of the directors.

Upon clicking "Submit" you will be redirected to the secured payment processing website. Please be advised that without payment your application will remain on hold.