Child's Name: *

First Name

Last Name

Child's Birthday:

MM

DD

YYYY

Home Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Class enrolling for August of 2025 *

Kitah Alef - 15 months by Sept 1

Kitah Bet- 2 years old by Sept 1

Kitah Gimmel- 3 years old by Sept 1

Kitah Daled- 4 years old by Sept 1

Parent # 1 Name: *

First Name

Last Name

Phone *

(###)

###

####

Parent # 2 Name:

First Name

Last Name

Phone*

(###)

###

####

Are siblings enrolled or enrolling for the 2025-2026 school year?

Yes

No

How would you like to pay your 2025-2026 Tuition? *

I will make 10 monthly payments beginning July 1, 2025.

I will make a 1 time payment for the total of tuition and security fees.

BY CHECKING THE ITEMS BELOW, YOU AGREE TO THE FOLLOWING TERMS: *

I hereby enroll my child in the Beit Blumi Jewish Early Childhood Center at Chabad-Lubavitch of Greater Boynton Beach.

I understand and agree to the terms as stated on this form. I hereby agree to pay the full amount due for those minimum enrollment terms.

In the event of an emergency if I am unable to be contacted, I hereby grant permission to the Beit Blumi Jewish Early Childhood Center to authorize any emergency action necessary to ensure the safety of my child.

I am aware that the use of family members’ names and likenesses for promotional and/or archival purposes at the Beit Blumi Jewish Early Childhood Center discretion without compensation.

Participation in any Beit Blumi Jewish Early Childhood Center activities and use of any recreation facilities involves a risk of accidental injury despite all safety precautions. Having been informed of the activities conducted at the Beit Blumi Jewish Early Childhood Center, I, as an individual or as a parent or guardian of the participant named herein, assume all risks and hazard incidental to the activities and release from responsibility and agree to indemnify and hold harmless the Beit Blumi Jewish Early Childhood Center, its officers, directors, independent contractors, volunteers and all employees for any illness or injury to me or my children or family members occurring during his/her participation in any activities or use of any recreation facilities at/or conducted by the Beit Blumi Jewish Early Childhood Center.

I agree to read the Beit Blumi Jewish Early Childhood Center’s Parent Handbook and will abide by all Beit Blumi Jewish Early Childhood Center’s policies stated therein. This includes mandatory participation for ALL students in the Teaching Strategies GOLD online assessment system.

I agree to sign and return all required forms before the start date of the program.

I am aware the school will use photographs of my child/children in printed materials or on our website/e-mail/social media. Names of children will never be listed.

In order to better serve your children, it may be helpful to contact the school he/she previously attended.

All paperwork, including the signed tuition contract and medical forms must be received via Brightwheel by June 15, 2025.

I am responsible for the entire year tuition even though it is broken down into 10 monthly payments regardless of vacation, absences or removal from the program.

I agree to pay the annual $1,000 Security Fee