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BTC Early Childhood Inquiry Form
Please verify reCaptcha before submitting the form.
As the only NAEYC accredited Jewish educational program in South Palm Beach County, The Ruth and Edward Taubman Early Childhood Center at B'nai Torah is "The Smartest Choice in Early Childhood Education." Our unique, developmentally appropriate curriculum provides a healthy self-image and independence for your child in a warm, welcoming environment.
Everyone must provide proof of state mandated immunization for admission.
No exceptions.
Today's Date:
Are you a Member of B'nai Torah?
Yes
No
How did you hear about our program?
*
Guardian #1 - First Name
*
Guardian #1 - Last Name
*
Guardian #1 - Email Address
*
Guardian #1 - Mobile Phone
*
Address
*
City
*
State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Zip Code
*
Is there a Guardian #2?
Please Select One
Yes
No
*
Guardian #2 - First Name
*
Guardian #2 - Last Name
*
Guardian #2 - Email Address
*
Guardian #2 - Mobile Phone
*
Does Guardian #2 live at the same address?
Please Select One
Yes
No
*
Guardian #2 - Address
*
Guardian #2 - City
*
Guardian #2 - State
--Select State--
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Puerto Rico
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
*
Guardian #2 - Zip Code
*
How many preschool age children are in your household?
Please Select One
One child
Two children
Three children
Child 1 - First Name
Child 1 - Last Name
Child 1 - Date of Birth
Child 1 - Gender
N/A or Unknown
Male
Female
Program of interest:
Please Select One
Family Time (Birth - 2 yrs old)
Kachol - 2s (Must be 2 by September 1st)
Adom - 3s (Must be 3 by September 1st)
Yarok - 4s (Must be 4 by September 1st)
*
Has your child received all state-mandated vaccines?
Please Select One
Yes
No
Please be aware that we do NOT accept religious exemption.
*
Is your child currently enrolled in another program?
Please Select One
No
Yes
*
Does your child receive any early intervention?
Please Select One
No
Yes
Please indicate any areas of intervention:
Behavioral
Occupational Therapy
Physical Therapy
Speech
Other
*
Please tell us more about your child:
Please share any information that will help to give us a general "snapshot" of your child. You may also elaborate here regarding interventional therapy that your child receives, if any.
Child 2 - First Name
Child 2 - Last Name
Child 2 - Date of Birth
Child 2 - Gender
N/A or Unknown
Male
Female
*
Program of interest:
Please Select One
Family Time (Birth - 2 yrs old)
Kachol - 2s (Must be 2 by September 1st)
Adom - 3s (Must be 3 by September 1st)
Yarok - 4s (Must be 4 by September 1st)
*
Has your child received all state-mandated vaccines?
Please Select One
Yes
No
Please be aware that we do NOT accept religious exemption.
*
Is your child currently enrolled in another program?
Please Select One
No
Yes
*
Does your child receive any early intervention?
Please Select One
No
Yes
Please indicate any areas of intervention:
Behavioral
Occupational Therapy
Physical Therapy
Speech
Other
Please tell us more about your child:
Please share any information that will help to give us a general "snapshot" of your child. You may also elaborate here regarding interventional therapy that your child receives, if any.
Child 3 - First Name
Child 3 - Last Name
Child 3 - Date of Birth
Child 3 - Gender
N/A or Unknown
Male
Female
*
Program of interest:
Please Select One
Family Time (Birth - 2 yrs old)
Kachol - 2s (Must be 2 by September 1st)
Adom - 3s (Must be 3 by September 1st)
Yarok - 4s (Must be 4 by September 1st)
*
Has your child received all state-mandated vaccines?
Please Select One
Yes
No
Please be aware that we do NOT accept religious exemption.
*
Is your child currently enrolled in another program?
Please Select One
No
Yes
*
Does your child receive any early intervention?
Please Select One
No
Yes
Please indicate any areas of intervention:
Behavioral
Occupational Therapy
Physical Therapy
Speech
Other
Please tell us more about your child:
Please share any information that will help to give us a general "snapshot" of your child. You may also elaborate here regarding interventional therapy that your child receives, if any.
Mon, June 5 2023 16 Sivan 5783