School Enrollment Form

Enrollment Form - Cost $ 100.00

First Name:

Last Name:

E-Mail:

Phone:

Street:

City:

State or province:

Postal/Zip Code:

Last Name

First Name

First Name (Hebrew)

Age

Date of Birth

Street

City State

Postal Code

Home Phone

Parent (not registering)

Name

Occupation

Work phone

Cell Phone

Email

Emergency Contact 1 - Name

Emergency Contact 1 - Phone

Emergency Contact 1 - Relation to Child

Emergency Contact 2 - Name

Emergency Contact 2 - Phone

Emergency Contact 2 - Relation to Child

Emergency Contact 3 - Name

Emergency Contact 3 - Phone

Emergency Contact 3 - Relation to Child

Full Day 9:00 AM-3:30 PM (choose one of the following options):





Morning program 9:00 AM - 12:30 PM (choose one of the following options):





Afternoon program 12:30 PM – 3:30 PM (choose one of the following options):





Sunrise Explorers 8:00 AM – 9:00 AM (choose one of the following options):





MJP Chugim 3:30 PM - 4:30 PM (choose one of the following options):





Late Care 4:30 PM - 5:00 PM (choose one of the following options):





Start Date Desired

Deposit & Registration Fee - $100.00

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Mequon Jewish Preschool
School Enrollment Form
11112 N. Crown Court
Mequon, WI 53092
Phone: (262) 242-KIDS (5437)
Fax: (262) 512-5437