Aleph Infant and Toddler Registration

Date*

Name of Applicant*

First Name Last Name

Child's Name*

First Name Last Name

Child's Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number

Area Code Phone Number

Birth Date*

Month Day Year

Birth Place*

Aleph Preschool is open Monday– Friday

Half Day 8:30 AM-12:30 PM
Full Day 8:30 AM-2:45 PM

A late pick-up fee of $25 will be charged to your account if your child is picked up more than 10 minutes after his/her scheduled time.

Tuition is based upon a yearly schedule. Tuition is the same each month September-August even if there are days off due to holidays or sickness. At signing of contract, the first month and last month’s tuition is due.

Select One:*

Full Days: 8:30 am - 2:45 pmHalf Days: 8:30 am - 12:30 pm

Do you need aftercare?*

Yes, I will be needing aftercare up until 4:30 PM. I will also notify Naomi in the playground app each Sunday a tentative week schedule for aftercare. Fee is $25/hourNo

Father's Name

First Name Last Name

Father's E-mail

Father's Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Father's Phone Number

Area Code Phone Number

Father's Occupation

Father's Business Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mother's Name

First Name Last Name

Mother's E-mail

Mother's Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Mother's Phone Number

Area Code Phone Number

Mother's Occupation

Mother's Business Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Child is to be fed the following liquids:*

BreastmilkFormulaMilk

What brand formula does your child use?*

Please specify what kind of milk your child uses:* For example, whole or specialty milk

Child now uses:*

BottleCup

How often and when does your child use a bottle?*

What age do you plan to introduce your child to a cup*

How often and when does your child use a cup?*

Child is currently on solid foods?*

YesNo

Child can feed itself?*

YesNo

Child now uses:*

SpoonFork

What age do you plan to introduce your child to a fork?*

What age do you plan to introduce your child to a spoon?*

Food Groups Age Specific Food Consistency

Bread*

StrainedWholeChopped

Cereal *

StrainedWholeChopped

Fruits*

StrainedWholeChopped

Vegetables*

StrainedWholeChopped

Meats*

StrainedWholeChopped

Do you have any special instructions from the child's pediatrician relating to diet?

How many ounces of milk/breastmilk does your child drink daily?*

Approximately what time do you usually offer your child solid foods?*

Healthy foods child likes:*

Foods child dislikes:*

List any food allergies:*

List any other types of allergies*

Allergy special instructions:*

Sleeping Patterns: Sleeping Schedule

Does your child take a nap in the morning?*

YesNo

Approximately what time?*

Usually how long?*

Does your child take a nap in the afternoon?*

YesNo

Approximately what time?*

Usually how long?*

List any transitional objects (blankets, pacifier, etc.) that your child uses:*

Medications

Medication(s) taken (including inhaler):

How often:

Diapering And Toilet Learning Plan

Infants and toddlers will be checked frequently and will be kept clean and dry. During arrival, the family will complete a diaper check before the family departs. Each family is required to provide the center with diapers and wipes.

Child uses:*

What brand diapers?*

What brand wipes?*

What brand training pants?*

Any other products which family will supply to be used on your child:

Special Instructions: Note: A completed Non-Prescription Medical Instruction, Consent and Waiver form on file for the use of all topical ointments (diaper ointments, sunscreen, mosquito repellent etc.)

At what stage of development does the family anticipate starting the introduction of a potty chair:*

At what stage of development does the family anticipate starting the introduction of a child-sized toilet?*

At what stage of development does the family anticipate starting the introduction of underwear?*

Individual Infant and Toddler Activities

What songs do you sing with your child?*

Families are encouraged to contribute ideas to the plan. Please discuss any special exercises or helpful accommodations for your child:*

Payment:*

I will pay the deposit today - $650Please bill me within the app for all fees

Total:

$0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment

Credit Card Pay by Check

Postal / Zip Code

Country

Aleph Infant and Toddler Registration

Student's Information

Tuition Schedule and Fees

Enrollment Information

Family Information

Needs/Service & Feeding Plan

Payment