CSI - Preschool - Spring Registration

Spring Registration

Please complete the form below for spring registration.

Child's Name:
	Male Female
Date of Birth (MM/DD/YY):
Age as of January 1, 2008:
Address:
City:
State:
Zip:
Home Phone:
Mother
Name:
Cellular Phone:
Email Address:
Father
Name:
Cellular Phone:
Email Address:
Emergency Contact
Name:
Phone:
Are you a member of Congregation Shearith Israel? Yes No
Are you a member of another synagouge? Yes No

Please register my child for:

Parent and me (6 to 18 months)
Tuesdays 9:30 to 10:30

Baby Massage (Prenatal to 12 months)
Wednesdays 9:30 to 10:15

Baby Massage (12 to 18 months)
Wednesdays 10:30 to 11:15

Bim Bam Baby with Kindermusik (3 to 18 months)
Thursdays 9:30- to 10:15

Bim Bam Baby with Kindermusik (18 to 36 months)
Thursdays 10:30- to 11:15