Pre-1A Program Registration/Enrollment Form

Cheder Menachem Pre-1A Program Enrollment

Complete this form to start the enrollment process for the upcoming school year.
Cheder Menachem Of Inverrary Pre-1A infuses children with the warmth and spirit of Chabad Lubavitch values.

We accomplish this through a high-quality curriculum taught by dedicated teachers, hands on activities and extracurricular programming in an atmosphere of true Ahavas Yisrael and Chassidishkeit.

Our aim is to nurture, inspire and empower students to reach personal excellence. Within a warm environment, we cultivate within students a love for learning, guide them in developing academic and social skills, and instill true confidence for each individual child.
Student Name

First NameLast Name
What would you like your child to be called?
Date Of Birth

MonthDayYear
Date
Age
Hebrew Birthday

MonthDayYear
Date
Gender
Address
Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code
School Last Attended
Parent Information
Father's Name

First NameLast Name
Occupation
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Father's Email
example@example.com
Mother's Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Mother's Email
example@example.com
Emergency Contact Person
First Name
Last Name
Emergency Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Emergency contact relationship
Medical & Developmental Information
Pediatrician Name
Pediatrician Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Does your child have any allergies?
Allergy Details
Is your child up to date with their vaccinations?
Does your child have any medical conditions?
Medical Condition Details
Does your child take any medication?
Medication Details
Has your child received developmental, speech, or early intervention support?
Explanation of Support Received
Pickup & Authorization
Authorized Pickup Persons
Food Program
Will your child participate in the school food program?
If yes, please describe any dietary restrictions or allergies.
Child Profile
This section helps our teachers better understand your child so we can create the most supportive and personalized classroom experience.
Describe your child’s personality
What does your child enjoy most?
How does your child respond to structure or group settings?
Are there any areas where your child may benefit from additional support or guidance?
Is there anything you feel would be helpful for our teachers to know to best support your child?
Are there any values, priorities, or educational goals that are important to your family?
Attendance & School Expectations
Which attendance expectations do you acknowledge?
Please note: Attendance and punctuality are important to your child’s classroom experience and daily routine.
Behavior & School Partnership Agreement
Behavior Agreement
Tuition & Financial Agreement
The school will בעז״ה be accepting Step Up and Gardiner scholarships. In the event that there is a delay with our school application, we will work with you to find an alternative solution so you can still receive those funds, and we will not place the full tuition burden on your family during that time.
I acknowledge tuition is $12,000 for the school year
I acknowledge a $500 deposit is required to secure enrollment
I acknowledge tuition is not prorated for absences or withdrawals unless specified
Consent & Photo Release
Consent to emergency medical treatment if needed
Permission for school use of photos/videos (internal/community use)
Final Confirmation
Parent/Guardian Full Name

First NameLast Name
Date

MonthDayYear
Date
Confirmation
Parent/Guardian Acknowledgment

Please submit payment of $500 to process your enrollement.

Payment will be applied towards tuition.
Zelle:

Chedermenachemfl@gmail.com

Credit Card

Enrollment Fee

Will be applied towards tuition

$500.00 Quantity

Total

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Should be Empty:

Cheder Menachem Pre-1A Program Enrollment

Address

Parent Information

Emergency Contact Person

Medical & Developmental Information

Pickup & Authorization

Food Program

Child Profile

Attendance & School Expectations

Behavior & School Partnership Agreement

Tuition & Financial Agreement

Consent & Photo Release

Final Confirmation

Credit Card