Preschool Application 2023-2024

Preschool Registration Application

2023/2024

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*

MonthDayYear

Birth Country*

United StateOther

What age were they when they came to the US?*

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*

FemaleMale

Applying for Grade*

Gan Shemesh (Mixed ages)Daycare (3 months – 17 months)Toddler (18 months by Oct. 15th)*Nursery (3 yrs by Oct. 15th)Pre-K (4 yrs by Oct. 15th)Kindergarten (5 yrs by Oct. 15th)

Gan Shemesh*

Gan Shemesh 9:00 AM -3:00 PM

Daycare (3 months – 17 months)*

Daycare 9:00 AM -3:00 PM $15,795Daycare 8:10 AM -3:00 PM $17,995Daycare 9:00 AM -4:00 PM $18,395Daycare 8:10 AM -4:00 PM $20,595

Toddler (18 months by Oct. 15th)**

Toddler 9:00 AM -1:00 PM $9,750Toddler 8:10 AM -1:00 PM $11,950Toddler 9:00 AM -3:00 PM** $14,225Toddler 8:10 AM -3:00 PM** $16,375

Nursery (3 yrs by Oct. 15th)*

Nursery 9:00 AM -3:00 PM $11,150Nursery 8:10 AM -3:00 PM $13,350

Pre-K (4 yrs by Oct. 15th)*

Pre-K 9:00 AM -3:00 PM $11,600Pre-K 8:10 AM -3:00 PM $13,800

Kindergarten (5 yrs by Oct. 15th)*

Kindergarten 9:00 AM -3:00 PM $14,020Kindergarten 8:10 AM -3:00 PM $16,220

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

**Includes nap time.

FRIDAY DISMISSAL AT 1:00 PM FOR ALL

Are you interested in AfterCare from 3:00 pm to 4:00 pm? (Registration for AfterCare will be open in Spring 2023)*

YesNo

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

YesNo

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:*

Please Explain:*

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

YesNo

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?*

YesNo

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

FAMILY INFORMATION

Are both biological parents living?*

YesNo

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?*

YesNo

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

YesNo

SIBLINGS INFORMATION

Did you have any other children who attended LPS?*

YesNo

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?*

YesNo

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.*

YesNo

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*

YesNo

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:*

YesNo

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 - $990 per application - $850 Early Bird (Ends Dec. 15)
The application fee is non-refundable and doesn't get applied toward the cost of tuition.

Security Fee - $475 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.*

I understand