Congregation Shearith Israel
The Spanish and Portuguese Synagogue
8 West 70th Street
New York, NY 10023
TODDLER PROGRAM
(For ages 16 months-33 months)Caregiver attendance required
Mondays and Wednesdays: 9:30-11:30
2010-11 (Sept. 8th - June 6th)
Fall and Spring Registration
Name of Child: ___________________________________________DOB: m d y____
Name of Parent/s: _____________________________________________________________
Home address:________________________________________________________________
Home Telephone No: __________________________________________________________
Work Telephone No./s: ________________________________________________________
Email Address: ________________________________________________________________
Caregiver attending (if other than above):________________________________________
Emergency Contact:__________________________ Emergency No:____________________
Doctor’s Name: _______________________________ Doctor’s No: ___________________
Allergies?_____________________________________________________________________
Anything else we should know?_________________________________________________
Please mark your selection from the following choices:
Full Year : 2010/2011
(Full Year enrollment by Sept. 1st –get 10 per cent discount as follows)
(2 day) Member: $2475_____ Non-Member: $2970____
(1 day) Member: $1470_____ M__ W__ Non-Member: $1780____
Fall 2010: Sept. 8th - Dec. 22nd: Mondays & Wednesdays (No groups: Oct. 11, Columbus Day)
(2 day) Member: $1070_____ Non-Member: $1285____
(1 day) Member: $640_____ M__ W__ Non-Member: $770____
Spring 2011: Jan. 3rd – June 6th: Mondays & Wednesdays (No groups: Jan. 17, MLK Day; Feb. 21, President’s Day; Apr. 18, 20, 25, Passover Holiday; May 30, Memorial Day)
(2 day) Member: $1585_____ Non-Member: $1900____
(1 day) Member: $950_____ M__ W__ Non-Member: $1140____
Date: ________________ Amount: $____________
Synagogue: ______________Parent/Guardian Signature: _______________
