Registration

$125 registration fee to reserve your child’s space
will be charged at the time of registration.

Mother's Information

Father's Information

Same as Mother's Address

Permission

I give Temple Tot’s permission to use my child’s picture in newspapers, magazines, publicity brochure, our internet website, or other media forms.




Emergency Contacts
1. 


2. 



Tuition

Are you a member?   


Your banking and credit card information is kept secure using SSL 256-bit encryption.

Automatic Funds Transfer Payments

I authorize Temple Emanu-El to perform an automatic funds transfer on the 1st of each month from my checking account to fulfill my child’s Temple Tots preschool tuition. Charges will be based on the number of days I have committed my child to attend. If my automatic funds transfer payment fails to process due to insufficient funds or for any other reason, I authorize Temple Emanu-El to collect a $25 fee by electronic charge to my checking account identified below. Please enter your checking account number.



Same as Mother's Address  Same as Father's Address















By check this box you are authorizing Temple Emanu-El to perform an automatic transfer as stated above.



Credit Card Payments

I authorize Temple Emanu-El to charge my credit card on the 1st of each month to fulfill my child’s Temple Tots preschool tuition. Charges will be based on the number of days I have committed my child to attend. If my credit card payment fails to process due to insufficient funds or for any other reason, I authorize Temple Emanu-El to collect a $25 fee by electronic charge.

Credit Card Type:         


  (Exactly as it appears on card)






Same as Mother's Address  Same as Father's Address










By check this box you are authorizing Temple Emanu-El to charge my credit card as stated above.