2014-15 Enrollment Application

2014-15 ENROLLMENT APPLICATION

Thank you for your interest in Gan Shalom! Upon receipt of your completed application, a welcome packet will be forwarded to you. To complete this e-form, save the form using the [save as] feature. Then type information in the fields and use the tab key to advance to the next field.

Child Information First/Middle/Last Name: Birthdate (MM/DD/YY):

Gender (check box): Female Male Hebrew Name:

Address/City/Zip:

Family Information Parent or Guardian 1 First/Middle/Last Name:

Address/City/Zip:

Email:

Phone #s (xxx)xxx-xxxx: Cell: Home: Business:

Parent or Guardian 2 First/Middle/Last Name:

Address/City/Zip:

Email:

Phone #s (xxx)xxx-xxxx: Cell: Home: Business:

Jewish Community Affiliation It is the policy of Gan Shalom, The Jewish Center for Early Childhood Development, to accept Jewish and non-Jewish children, giving enrollment priority to the Jewish community. Our policies require that we keep records detailing the enrollment ratio of Jewish and non-Jewish children. Please check all statements that apply.

Child is Jewish by descent or conversion Child is being raised Jewish Parent, grandparent or guardian is affiliated with the Jewish Federation of Greater Des Moines Parent, grandparent or guardian is affiliated with Beth El Jacob Parent, grandparent or guardian is affiliated with Tifereth Israel Synagogue Parent, grandparent or guardian is affiliated with B’nai Jeshurun Parent, grandparent or guardian is affiliated with Lubavitch of Iowa/Chabad Synagogue

Gan Shalom 2014-15 Enrollment Application 021914 Page 1 Child is being raised Jewish but family is not affiliated with an area congregation Child is not Jewish but lives with a Jewish family within the Greater Des Moines area Child is not Jewish and not being raised Jewish

Gan Shalom 2014-15 Enrollment Application 021914 Page 2 2014-15 Tuition Fee Schedule – 9-month program Half Days 9:00 AM – 11:45 AM Full Days 9:00 AM – 3:30 PM Session Preferences (please check one) Toddler Preschool Program (ages 2-3) Preschool Program (ages 3-4) PreK Preschool Program (ages 4-5) [Entering Kindergarten Fall 2015] 3 Half Days (M, W & F) 5 Half Days (M, T, W, Th & F)

$3,200 ($355.56 per month) $3,800 ($422.22 per month) 5 Full Days (M, T, W, Th & F) $7,000 ($777.78 per month) 5 Half Days (M, T, W, Th & F) 5 Full Days (M, T, W, Th & F) $4,000 ($444.44 per month) $7,000 ($777.78 per month)

3 Full Days (M, W & F) $4,410 ($490.00 per month)

5 Full Days (M, T, W, Th & F) $7,350 ($816.67 per month)

The 2014-15 School Year begins on August 18, 2014. If enrolling midyear, please indicate the date you would like your child to start coming to school:

Extended Care Options (please check one) Early Bird – 7:30 AM – 8:55 AM $15/week Stay-n-Play –3:40 PM – 5:30 PM $15/week Drop-in Extended Care - $50 punch card based on space available ($5/punch)

Transportation (please check one) Morning pickup at Beth El Jacob Synagogue $10/week Afternoon drop-off at Beth El Jacob Synagogue $10/week

Need-based Scholarship Options (please check one) The Jewish Federation is committed to providing a quality preschool for our Jewish community. Scholarships are available for families raising Jewish children who cannot afford to pay full fees. Not applying for a need-based scholarship Please forward scholarship application form

Enrollment Registration Fee (applications are considered on a first come, first served basis) A non-refundable registration fee of $100 made out to The Jewish Federation of Greater Des Moines is required. This fee is applied toward the overall tuition fee. Please check one. A check for $100 is enclosed A check for $100 will be sent to The Jewish Federation, attention Gan Shalom, 33158 Ute Avenue, Waukee, IA 50263 Please charge credit card: Type of Card (check one) VISA MasterCard American Express Discover Card #: Expiration Date (MM/DD/YY):

Payment Options For your convenience, three payment options are provided. Please check one. Will pay full school year tuition on or before 8/18/14 (subtract $500 discount for full day or $200 discount for half day session) Enrolling mid-year and will pay full prorated tuition within one week of start date (subtract $100 discount for full payment) Will pay monthly tuition payment via check (invoice will be sent; due on the 1st day of each month) Will pay monthly tuition payment via credit card (credit card will be run on the 1st day of each month) Type of Card (check one) VISA MasterCard American Express Discover

Gan Shalom 2014-15 Enrollment Application 021914 Page 3 Card #: Expiration Date (MM/DD/YY):

Payment Options Enrollment Terms: Gan Shalom tuition is based on a 9-month program. Refunds are not provided for absence, inclement weather, ordinary illness or family vacations; however, a pro-rated adjustment may be made should a child enroll mid-year, be absent due to illness for longer than one month, or if the family moves out of the local area. Families enrolling two or more children are entitled to a 5% discount per family. Enrollment may be canceled if tuition obligations are not met.

I accept the enrollment and tuition payment terms and request an official Welcome Packet be forwarded to my/our attention. I understand the Welcome Packet will contain medical and release forms that must be turned in prior to my child’s first day of school.

Parent Signature (e-signature is accepted): Save this form using the [Save as] feature and forward to [email protected] or print this form and send to Gan Shalom at The Jewish Federation of Greater Des Moines, 33158 Ute Avenue, Waukee, IA 50263.

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