Abigail R. Cohen Preschool and Laurie Wagman Playschool
Application
(Please Print)
Child’s Name
Birth date
/
/
Gender ______________
Address
City/State/Zip
Home Phone
Parent 1
(
)
Parent 2
Address
Address
If different than above
If different than above
City/St/Zip
City/St/Zip
If different than above
If different than above
Cell Ph _(_______)_____________________________________
Cell Ph _(_______)___________________________________
Work Ph
Work Ph
(
)
Email
(
)
Email
Are you members of Beth Zion-Beth Israel?  Yes
 No
Are you interested in membership information?  Yes
Check Applicable Schedule:
Playschool
 Playschool 2 days T/TH, 8:30am- 12:00 pm
 Playschool 3 days M-W-F, 8:30am – 12:00 pm
 Optional Playschool Lunch Bunch until 1:00 pm
Preschool
 Preschool 3 days M-W-F, 8:30am - 1:00pm
 Preschool 5 days M-F, 8:30am - 1:00pm
 Optional Preschool Afternoon Enrichment until 3:00pm
 Pre-Kindergarten 5 Days M-F, 8:30am - 3:00pm
Indicate desired session(s):
 Summer (Playschool Only)
 Fall/Spring
 Year 20
*Application Fee: A non-refundable application fee of $75.00 is required at time of application.
* 2.5% processing fee is applied to credit card payments
Return to: Temple Beth Zion Beth Israel Early Childhood
th
300 South 18 St. Philadelphia, PA 19103 or email: [email protected]
All classes will be filled on a first come first served basis, with preference given in the following order:
Synagogue members, returning students or siblings of former students, and date of application.
 No