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Gan Kochavim, Jewish Preschool in New Jersey, Jewish daycare in Passaic

973 - 471 - PLAY (7529)

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SAFETY FIRST: We're taking extra measures to ensure your children are safe in our school. More details

Summer Camp Admission Application

Child's Information

*Child's First name

Child's Middle Name

*Child's Last name

Child's Hebrew Name

Child's Nickname

*Child's Date of Birth

*Child's Sex

Male

Female

My child has not been born yet

Child's Home Phone

*Child's Home Address

*Child's City

*Child's State/Region

*Child' Postal Code

Child's Country

*Please Upload a Recent Photo of Your Child

*Today's Date

Rates & Scheduling

Accepting all ages 6 weeks - 6 years

*How old will your child be at school start date?

Projected School Start Date

*Which session (duration) are you signing up your child for?

8 Weeks June 23 - Aug 15

9 weeks June 23- Aug 22

Available Camp Hours Include:

Monday–Thursday 7:30am-6:00pm & Friday 7:30am-2:00pm

*Desired school hours: Mon-Thu (click all that apply)

7:30am-3:00pm

7:30am-4:00pm

7:30am-5:00pm

7:30am-6:00pm

8:00am-3:00pm

8:00am-4:00pm

8:00am-5:00pm

8:00am-6:00pm

8:30am-3:00pm

8:30am-4:00pm

8:30am-5:00pm

8:30am-6:00pm

9:00am-3:00pm

9:00am-4:00pm

9:00am-5:00pm

9:00am-6:00pm

*Desired school hours: Friday (click all that apply)

7:30am-1:00pm

7:30am-2:00pm

8:00am-1:00pm

8:00am-2:00pm

8:30am-1:00pm

8:30am-2:00pm

9:00am-1:00pm

9:00am-2:00pm

Medical Details

*Child's Primary Physician

*Physician's Phone Number

Known Allergies

*Does Your Child Have a Medical Condition?

Yes

Does your child have any special needs we should be aware of? Please provide the school with your child’s IEP or IFSP, if applicable.

I authorize Passaic Clifton playgroup aka Gan Kochavim Preschool to seek medical care for my child in the event of an emergency

I authorize Passaic Clifton playgroup aka Gan Kochavim Preschool to seek medical assistance for my child

*Your Signature

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973-471-PLAY (7529)

passaiccliftonplaygroup@gmail.com

Address

Ahavas Israel: 181 Van Houten Ave. Passaic, New Jersey 07055

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