Chai Daycare Register Form - Chabad Jewish Center of Prospect Heights
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  • Registration Form 2017/2018

  • Please submit this registration form with a copy of your child’s birth certificate and your $200 non-refundable registration fee to:

    Chai Day Care Office:
    569 Vanderbilt Ave. Brooklyn, NY
    Please make checks payable to Chai.
  • 1. Child's Information

  • 2. Parental/Guardian Information

  • Please mark your selection below: 

  • Pick a Date
  • Any specific days of the week you are interested in, or are you flexible?

    We cannot guarantee day preference. Remember, we can best provide for those who are flexible. 

  • * Please note that if there will be any changes from the above selected days, there will be an additional $150 charge. Changes will be made upon school’s discretion.

  • 3. Personal History

  • Any additional information such as discipline, child’s communication, comfort, etc., you feel we should know?

  • 4. Pick Up

  • 5. Family Information

  • 6. Permission for Health Care

  • 7. Emergency Contact Information

  • Please indicate telephone numbers where you and another authorized person can be contacted in case of emergency.

  • 8. First Aid

  • In case of an emergency, I authorize the staff to provide any First Aid care deemed necessary for my child.

  • Pick a Date
  • 9. Emergency Care

  • In case of an emergency in which I cannot be reached, the physician listed above and the local hospital are hereby authorized to provide any emergency care deemed necessary for my child.

  • 10. Health Records Transfer

  • In case of an emergency, I hereby authorize the transfer of my child’s record to the local hospital.

  • Pick a Date
  • I will not hire any staff member as a personal babysitter or in any other capacity.

  • Pick a Date
  • I have reviewed the guidelines and I hereby register my child 2017– 2018 school year.

  • Pick a Date
  • 11. Emergency Information

  • Important phone numbers:

  • Alternate Emergency Contact Person(s):

  • 10. Permission for Trips

  • I give permission to my son/daughter to participate in supervised curricular and extracurricular activities that may include leaving the daycare building.

  • 12. Permission for Pictures

  • Pick a Date
  • Pick a Date
  • 13. Payment Information

  • A $200 non-refundable registration fee applies as part of this registration.

  • Credit Card
  • Should be Empty:
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