IEBECC & Camp Registration - Synagogue of the Suburban Torah Center (SSTC)

Child's First Name

Child's Last Name

Child's Hebrew Name

Date of Birth

Language Spoken at Home

Address Line 1

Address Line 2

Address City

Address State

Address ZIP

Custody Agreement

I am registering my child for:

IEBECC Fall Registration OnlyCamp Cochavim OnlyBoth IEBECC Fall Registration AND Camp Cochavim

Class

Extra Options

Early MorningExtended DayAfter Care

Extra Options

Early MorningAfter Care

* Please select from the following IEBECC tuition payment plan options:

Please Select OnePay in full before the first day of schoolPay in two installmentsPay over 10 months

First Parent or Guardian

Child Lives With this Parent or Guardian

Title

First Name

Last Name

Relationship to Child

Hebrew Name

Home Phone

Mobile Phone

Employer

Employer Address

How Did you Hear About IEBECC?

Synagogue Affiliation If Not SSTC

Second Parent or Guardian

Child Lives With this Parent or Guardian

Title

First Name

Last Name

Relationship to Child

Hebrew Name

Home Phone

Mobile Phone

Employer

Employer Address

Siblings

Number of Siblings

Name

Date Of Birth

School or Childcare

Name

Date Of Birth

School or Childcare

Name

Date Of Birth

School or Childcare

Name

Date Of Birth

School or Childcare

Name

Date Of Birth

School or Childcare

Name

Date Of Birth

School or Childcare

Social and Emotional Info

Previous School Experience

Describe how the child handles separation

Describe interactions

Child's Temperament

Adjectives describing child

Child's favorite activities

Child's angers and fears

To comfort child

Anything else we should know

Further Information

Authorized person to pick up from school

Relationship to child

Telephone

Authorized person to pick up from school

Relationship to child

Telephone

Emergency contact name

Relationship to child

Emergency contact telephone

Physician name

Physician telephone

Physician address

Insurance carrier

Policy Number

Group Number

Name of Policy Holder

Allergies

EpiPen

Medical conditions

* 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 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. IEBECC Handbook can be viewed and downloaded HERE

* I am responsible for adhering to the policies and procedures as presented in the Parent Handbook.

I am responsible for adhering to the policies and procedures as presented in the Parent Handbook.

* I am aware that the Parent Handbook outlines the following: Discipline Policy, Expulsion Policy, Healthy Foods Policy, Communicable Disease Policy, Social Media Policy and Policy on the Release of Children.

I am aware that the Parent Handbook outlines the following: Discipline Policy, Expulsion Policy, Healthy Foods Policy, Communicable Disease Policy, Social Media Policy and Policy on the Release of Children.

* 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 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.

IEBECC NJ Licensing form can be completed HERE

* I have received and read a copy of the Expulsion Policy 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

Download IEBECC's Expulsion Policy HERE

* I am aware that my child’s file, including medical information and emergency contact information, must be kept up-to-date at all times.

I am aware that my child’s file, including medical information and emergency contact information, must be kept up-to-date at all times.

* I authorize and release Iris & Errol Berman Early Childhood Center from the need to keep a record of my child’s drop-off and pick up during the school year.

I authorize and release Iris & Errol Berman Early Childhood Center from the need to keep a record of my child’s drop-off and pick up during the school year.

* I have read the carpool procedure for the Iris & Errol Berman Early Childhood Center and I agree to comply with all the items mentioned. I understand that failure to comply will result in serious action. In addition I am aware that it is New Jersey State law that all children of this age MUST be in a child safety seat. I am assuming personal responsibility if these guidelines are not met.

I have read the carpool procedure for the Iris & Errol Berman Early Childhood Center and I agree to comply with all the items mentioned. I understand that failure to comply will result in serious action. In addition I am aware that it is New Jersey State law that all children of this age MUST be in a child safety seat. I am assuming personal responsibility if these guidelines are not met.

* I permit my child to take staff-supervised walks.

I permit my child to take staff-supervised walks.

Image Authorization

YesNoI 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.

* I understand that registration for the school year 2023/24 is not complete until the $1000 registration fee has been received by IEBECC

I understand that registration for the school year 2023/24 is not complete until the $1000 registration fee has been received by IEBECC

* I understand that registration for camp is not complete until the $100 registration fee has been received by IEBECC

I understand that registration for camp is not complete until the $100 registration fee has been received by IEBECC

Signature (please type full name)

Date