Alef Academy Online Registration Form 25-26
Returning Student
Child Information
First and Last Name
*
First Name
Last Name
Name Child is called:
Date of Birth
*
Gender:
Male
Female
Has your address changed in the last year?
*
No
Yes
Home Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Home Phone:
-
Area Code
Phone Number
Parent Information:
Have the names or contact information for the parents changed in the last year?
*
Yes
No
Parent #1 Name:
*
First Name
Last Name
Relationship to child:
Jewish
*
Yes
No
Other
Email:
*
example@example.com
Cell Phone:
*
-
Area Code
Phone Number
Address (If different from above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation:
Employer:
Work Phone:
-
Area Code
Phone Number
Employer Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent #2 Name:
First Name
Last Name
Relationship to child:
Jewish
Yes
No
Email:
example@example.com
Cell Phone:
-
Area Code
Phone Number
Address: (if different from above)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Occupation:
Employer:
Work Phone:
-
Area Code
Phone Number
Employer Address:
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
During the hours that my child is at Alef Academy, the best way to reach me is:
*
Call mother's cell phone
Call father's cell phone
Text mother
Text father
Remini message
Family Information
Has any family information changed in the past year?
*
Yes
No
Family Synagogue Affiliation:
Marital Status of Parents:
Languages spoken at home other than English:
Are there any conversions in the family?
*
Yes
No
Other
If yes, please specify who.
Previous Early Learning Experience
Name of Center
Attended from
blanks
to
blank
.
Back
Next
Emergency Contact/Authorized Pick Up Information
Licensing requires that we have 3 emergency contacts on file. Please include name, relationships, address, and phone number.
Would you like to update your emergency contacts/authorized pick up?
Yes
No
Contact #1
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
*
Relationship
Cell Phone
*
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
This contact is also authorized to pick up my child from school.
*
Yes
No
Contact #2
*
First Name
Last Name
*
Relationship
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
*
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
This contact is also authorized to pick up my child from school.
*
Yes
No
Contact #3
*
First Name
Last Name
*
Relationship
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Cell Phone
*
-
Area Code
Phone Number
Work Phone
-
Area Code
Phone Number
This contact is also authorized to pick up my child from school.
*
Yes
No
Signature of Parent or Guardian
*
Date:
*
Back
Next
Grandparent/Special Person Information
So we may include grandparents/special person in school special events.
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Email
example@example.com
Phone
-
Area Code
Phone Number
Maternal
Paternal
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
-
Area Code
Phone Number
Email
example@example.com
Maternal
Paternal
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
-
Area Code
Phone Number
Email
example@example.com
Maternal
Paternal
Name
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone
-
Area Code
Phone Number
Email
example@example.com
Maternal
Paternal
Back
Next
Medical and Emergency Form
Has your child's Dr changed in the last year?
*
Yes
No
Doctor's Name
*
First Name
Last Name
Name of Practice
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Has your preferred hospital changed in the last year?
*
Yes
No
In case of an emergency, my preferred hospital is:
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
*
-
Area Code
Phone Number
Does your child have medical insurance?
*
Yes
No
Has your child's insurance changed in the last year?
*
Yes
No
Insurance Provider
*
Insurance Policy Account #
Has your child's Dentist changed in the last year?
*
Yes
No
Dentist's Name
*
First Name
Last Name
Name of Practice
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Has your child's medical condition changed in the last year?
*
Yes
No
Medical Condition(s)
*
Yes
No
Is your child taking any medication at home?
*
Yes
No
If yes, please specify.
Has your child's allergies changed in the last year?
*
Yes
No
Does your child have any known allergies? (food, season, insects, etc.)
*
Yes
No
If yes, please specify reaction and treatment.
Is there anything special we should know about your child?
*
Back
Next
Statement of Authorization
Emergency Medical Treatment - I hereby give my consent to Alef Academy to call a doctor or emergency medical service and for that doctor or emergency service to provide emergency medical or surgical treatment to my child.
*
Yes
No
Sun Screen - I hereby give my permission for staff to apply Sunscreen to my child prior to outside play.
*
Yes
No
It is the parent’s responsibility to provide sunscreen with a minimum SPF of 15. In the event that my child’s sunscreen is not readily available
In the event that my child's sunscreen is not available, my child may use the sunscreen provided by the school.
I do not want my child to use any other sunscreen other than the one he or she brings.
Name of sunscreen and the SPF Number:
I hereby give permission to The Alef Academy to post my child's allergy information in the visible area of classrooms so that it is accessible to all staff.
*
Yes
No
Other
I hereby give permission to The Alef Academy to print our address and phone number on the class list, which will be distributed to my child's class and in the school phone directory which will be distributed to all Alef Academy families.
*
Yes
No
Other
Photo Release - I hereby grant my permission for my child's photo to be taken and displayed in classrooms, hallways, or stored in a file.
*
Yes
No
Other
Media Release - I hereby grant my permission for my child's photo to be taken and used in newsletters, flyers, and/or for any other advertisement purposes.
*
Yes
No
Other
Cot Permission - I herebygive my consent for my child to sleep on a cot during naptime. (18 months or older)
*
Yes
No
Other
I understand that tuition is due a month in advance:
*
Yes
No
Other
I understand that one-month’s tuition deposit is required. (This tuition will be applied to your last month’s tuition.)
*
Yes
No
Other
I understand that if it becomes necessary to withdraw or change my child's schedule, notice must be given in writing one month in advance. Tuition will be charged for one month after the date of notification of the withdrawal or change. (Deposit will be used to cover the last month's tuition)
*
Yes
No
Other
I understand that there is a $100 monthly security fee. (Scholarships Available)
*
Yes
No
Other
Is your child receiving CCAP?
*
Yes
No
I understand that I am required to register my child in FACTS for them to participate in Alef Academy as a CCAP recipient.
*
Yes
No
Are you interested in applying for a scholarship for the 25-26 school year?
Yes
No
I understand that I am required to complete a FACTS application in order to be eligible for a scholarship.
*
Yes
No
I have read the Parent Handbook. I understand all of the policies and procedures and agree to abide by them.
*
Yes
No
Other
PARENT HANDBOOK
Signature
*
Date:
*
Back
Next
Please note: We have shifted to a year round schedule (August 2025-August 2026). In the event it becomes necessary to change your child’s schedule at any point during the year, notice must be given in writing one month in advance.
Tuiton Information
I would like to register my child for the following days and times (for the new calendar year beginning in August):
2 Day HALF DAY
2 Day FULL DAY
3 Day HALF DAY
3 Day FULL DAY
5 Day HALF DAY
5 Day FULL DAY
I would like Before Care 8-9
Yes
No
I would like Before Care 8-9
2 Day: Tuesday & Thursday
3 Day: Mon, Wed, Fri
5 Day: Mon - Fri
I would like After Care 3-5
Yes
No
I would like After Care 3-5 (Aftercare is available until 4 PM on Fridays)
2 Day: Tuesday & Thursday
3 Day: Mon, Wed, Fri
5 Day: Mon - Fri
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Continue to Payment of Registration Fee
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Alef Academy Student Registration Fee
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