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NON MEMBER - Temple Shalom Nursery School Tuition Payment Form 2017-18

Please complete all applicable Child sections as well as the Parent and Family information sections. Signature is required in the Confirmation and Payment section.

Child 1

* Child 1 Name (First & Last)

Child 1 Program

D'vorim (Toddler 2 mornings) $5,620.00

D'vorim January start $4,374.00

Dubonim Toddler 3 mornings $8,482.00

Dubonim Toddler 5 mornings $9,879.00

Parparim (3-4 year olds) $9,879.00

Kochavim (4-5 year olds) $10,595.00

Has Child Had an Educational Screening or Early Intervention Services Prior to Admission to This School?

Yes (We will need a copy of the reports to keep in his/her file so we can properly support his/her learning)

Child 2

Child 2 Name (First & Last)

Child 2 Program

D'vorim (Toddler 2 mornings) $5,451.00

D'vorim January start $4,243.00

Dubonim Toddler 3 mornings $8,228.00

Dubonim Toddler 5 mornings $9,583.00

Parparim (3-4 year olds) $9,583.00

Kochavim (4-5 year olds) $10,277.00

Has Child Had an Educational Screening or Early Intervention Services Prior to Admission to This School?

Yes (We will need a copy of the reports to keep in his/her file so we can properly support his/her learning)

Child 3

Child 3 Name (First, Last)

Child 3 Program

D'vorim (Toddler 2 mornings) $5,451.00

D'vorim January start $4,243.00

Dubonim Toddler 3 mornings $8,228.00

Dubonim Toddler 5 mornings $9,583.00

Parparim (3-4 year olds) $9,583.00

Kochavim (4-5 year olds) $10,277.00

Has Child Had an Educational Screening or Early Intervention Services Prior to Admission to This School?

Yes (We will need a copy of the reports to keep in his/her file so we can properly support his/her learning)

Parent Information

* Parent 1 Name (First, Last)

Parent 1 Occupation

Parent 1 Cell Phone

Parent 1 Religion

Parent 1 Date of Birth

Parent 1 Place of Birth

Parent 2 Name

Parent 2 Occupation

Parent 2 Cell Phone

Parent 2 Religion

Parent 2 Date of Birth

Parent 2 Place of Birth

Marital Status

Second Address, If Applicable

Family Information

* Primary Language Spoken at Home

Sibling Names and Dates of Birth

* How Did You Hear About Temple Shalom Nursery School?

Confirmation and Payment

How many kids have you paid the deposit for?

I understand that the payment terms and conditions regarding enrollement are as follows: Temple Shalom Nursery School will reserve a space for my child/ren for the 2017/18 school year. If I withdraw my child/ren , the tuition, minus the Deposit will be refunded only if the School is able to find a new student/s to fill the spot/s.

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