Registration Form – N

Temple B’nai Torah Nursery School

2900 Jerusalem Avenue, Wantagh, NY 11793

(516) 781-KIDS

Register by February 15th and receive an Early Bird Discount

$100 per child for the 3 & 4 year old classes * $50 per child Toddler Class


Application Date: _____________________


Child’s Name: __________________________          Class: _________ Tuition: $_____________

Date of Birth: ___________________________           Deposit Received:              $_____________

Address: ______________________________           Monthly Payments:             $_____________    

Town, Zip: _____________________________                      Billing August 1st thru May 1st

Home Phone: __________________________                       Includes application fee received.

Cell Phone: ____________________________          No application will be processed without a NON-

Primary E-mail: _________________________           REFUNDABLE one (1) month tuition deposit.

PARENT (1)                                                                          PARENT (2)

Name: ________________________________          Name: ______________________________

Cell phone: _____________________________         Cell phone: __________________________

E-mail: ________________________________          E-mail: ______________________________

Vocation: ______________________________          Vocation: ____________________________

Employer: _____________________________           Employer: ____________________________

Business address:________________________         Business address: ______________________

Business phone: ________________________         Business phone: _______________________

EMERGENCY CONTACT:                                                 PHYSICIAN INFORMATION:

Name (1):_______________________________         Name: _______________________________

Address: _______________________________         Address: _____________________________

Phone: ________________________________         Phone: _______________________________

Name (2): ______________________________          Previous Nursery School:_________________

Address: _______________________________         How did you hear about TBT?_____________

Phone: _________________________________       School District:_________________________




The undersigned hereby applies for enrollment for my/our child _________________________ in the TEMPLE B’NAI TORAH NURSERY SCHOOL.


I/We understand that the tuition for the entire year is $_________ payable as follows:

NON-REFUNDABLE application fee of one month’s tuition is required at time of enrollment.


            Payments are due upon receipt of your monthly statement. You will be billed in

            Ten (10) monthly installments of $________ commencing on August 1st and ending

            With your last statement dated May 1st, payable upon receipt.


I/We understand that the deferred payments above are an accommodation extended to us. In the event our child fails to complete the school year, I/we are liable for payment of the balance of the tuition.


The attached fact sheet must be fully completed upon the signing of this agreement, and shall become part and parcel of this agreement.


The school reserves the right for final approval. It is understood that no refund of tuition for absences, school holidays, or vacation periods will be permitted. The school in its sole discretion has the right at any time to terminate a pupil’s enrollment for reasons including but not limited to: health, safety and/or emotional problems. In the event of such termination, the undersigned shall be entitled to a pro-rated refund.


Each child must have a complete medical examination by their physician before admission to school. The report of this exam together with complete immunization records and medical recommendations shall be filed with the school. A physician’s signature is needed to give the school permission to administer prescription drugs.


If emergency medical attention is necessary and the parent cannot be contacted, the school is hereby authorized to call the family physician or, if not available, any other licensed physician to render necessary aid. If necessary, the child will be taken to a hospital or health facility. Parent(s) shall be responsible for medical expense incurred for emergency treatment.


Enrollment in the school shall be granted without discrimination in regard to sex, race or color.


Class or teacher placement is at the sole discretion of the Director.



Parent’s Signature: ________________________________________       Dated: ________________



Parent’s Signature: ________________________________________       Dated: ________________