Early Childhood Center Admission Application - Form

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Early Childhood Center Admission Application

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GHC EARLY CHILDHOOD CENTER
515 Broadway Dobbs Ferry, NY 10522
914-693-4260 www.ghcny.org

APPLICATION OF ADMISSION
EARLY CHILDHOOD CENTER

SCHOOL YEAR: 2023-2024

APPLICANT INFORMATION
Child's Name
Last
Child's Name
First
Date of Birth:
Sex
Current address:
City
State
Zip Code
PARENT INFORMATION
Parent/Legal Guardian Name:
Last
Parent/Legal Guardian Name:
First
Occupation
Home Phone
Work Phone
Cell Phone:
Email:
Parent/Legal Guardian Name:
Last
Parent/Legal Guardian Name
First
Occupation:
Home Phone
Work Phone:
Cell Phone:
Email:
Family Synagogue Affiliation:
(If not applicable at this time, just state none)
Number of other children:
Name
Date of Birth
Name:
Date of Birth:
Name:
Date of Birth
PROGRAMS OF INTEREST

(Note: copy of Birth Certificate is REQUIRED for all programs listed)
Please select:Two-day 2 Year Old Program...............(2 by 12/31/23)...............Tuesday/ThursdayThree-day 2 Year Old Program.............(2 by 12/31/23)...............Monday/Wednesday/FridayFive-day 2 Year Old Program................(2 by 12/31/23)...............Monday - FridayThree-day 3 Year Old Program..............(3 by 12/31/23)...............Monday/Wednesday/FridayFive-Day 3 Year old Program.................(3 by 12/31/23)..............Monday - FridayFive-day 4 Year Old Program.................(4 by 12/31/23)..............Monday-Friday
Please advise how you heard of GHC's early childhood program
If you were referred by a current member, please advise by whom. If you heard of us through advertising, word of mouth, browsing the internet etc., please be as specific as possible. Thank you!.
A non-refundable deposit of $500.00 MUST accompany this application. Payment will be applied toward the 2023-2024 tuition. If you wish to pay by credit card, please click HERE and you will be directed to our donation/payment page. Click on the donation drop down button and go to the appropriate ECC program you are enrolling. You can also send in a check to our office. Please mark it "Deposit for (name of child) for 2023-2024 tuition..

PLEASE NOTE: GHC does not publish its tuition rates on its website. If you have not received a detailed list of our enrollment policies, including all class rates and if applicable, the special sibling discount we offer, please contact our Director of Education, Amy Kessler, at directored@ghcny.org.
E-signature of Parent or Guardian
Date:

Fri, June 2 2023 13 Sivan 5783