Address State --Select State-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Class Little Beginners 2's Program 3's Program 4's Program
First Parent or Guardian
Second Parent or Guardian
Siblings
Number of Siblings None 1 2 3 4 5 6
Social and Emotional Info
Previous School Experience
Describe how the child handles separation
Anything else we should know
Further Information
* I have read a copy of the Iris & Errol Berman Early Childhood Center’s Parent Handbook. I understand I am completely responsible for reading the Parent Handbook in its entirety before my child’s first day of attendance and should I have any questions or require clarification of any of the content, I am responsible for contacting the Iris & Errol Berman Early Childhood Center’s Director, Chaya Weisberg. I am aware that this Parent Handbook is not inclusive and is subject to change. * I have read and signed the Information to Parents document from the Department of Children and Families, Office of Licensing from the Iris & Errol Berman Early Childhood Center. * I have received and read a copy of the Expulsion Policy from the Iris & Errol Berman Early Childhood Center Image Authorization Yes NoI understand that Iris & Errol Berman Early Childhood Center routinely takes photographs and videos of various activities, including classroom and learning activities, involving Iris Berman Early Childhood Center students, staff, parents and other attendees, which may include my child/children and me. By indicating YES above I give the Iris & Errol Berman Early Childhood Center the right, permission or authorization to use, or publish in whole or in part, photographs or videos taken of the minor child /children listed below, separately or in conjunction with other photographs or videos for use in Iris & Errol Berman Early Childhood Center's print, online or video based marketing materials, as well as other Iris & Errol Berman Early Childhood Center publications.
DISCLAIMER: By typing your name below, you are signing this application electronically. You agree that your electronic signature is the legal equivalent of your manual signature on this application.