Mini Sinai Daycare Center Application

If you are looking to register only for the summer session (June 2022-August 2022) and not the September 2022-June 2023 school year, please email us at daycare@mtsinaishul.com.

Please note: Children must be at least 6 weeks old and under 24 months by September 1st, 2022 to enroll in the 2022-2023 school year program.

*Currently our infant room is full. Please email daycare@msjc.org to be added to the waitlist or to find out when the next available spot will be available.

Parent 1 First Name

Parent 1 Last Name

Parent 1 Email

Parent 1 Phone Number

Parent 1 Occupation

Parent 1 Employer

Home Address

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Phone Number

Parent 2 Occupation

Parent 2 Employer

Parent 2 Home Address (skip if same as above)

How many children are you registering

1*Please note, registration is $200 and is not applied to tuition. This saves your spot and is non-refundable.
*If registering for more than one child, a separate application must be filled out.

Child's First Name

Child's Last Name

Child's Birthday

* If child is not-yet born, please provide expected date.

Where is your child coming to our program from?

(i.e. home, nanny,another program)

My child will attend the following dates/hours:

Summer Months (June 20th- August 26th) (Tuition: $3,500/$3,700)2022-2023 School Year (September 6th-June 16th) (Tuition: $14,300 / $15,500)Regular Hours (M-Th 9:00am-4:00pm; F 9:00am-1/2pm) (see rates above)Extended Hours (M-Th 8:00am-6:00pm; F 8:00am-2/3pm) (see rates above)*Check all that apply

List any allergies:

Doctor's Name

Doctor's Phone Number

All children must have this medical form filled out by their child's physician to begin in the program:
New York State Health Care Form
Please email to daycare@mtsinaishul.com prior to start date.

Emergency Contacts:
We will always try the parents first. Please list two other emergency contacts if parents are unable to be reached. Please note, emergency contact #1 must be local.

Emergency Contact 1

Emergency Contact 1 Phone Number

Relation to child

Emergency Contact 2

Emergency Contact 2 Phone Number

Relation to child

Authorized pick-up
Please include name & phone number

In order to take every possible safety measure at dismissal, we require that each person, other than a parent, authorized to pick up your child be known to the director. In the event that someone not listed below will be picking up your child, please call the office before dismissal.

Please check the boxes below:

I hereby give permission to the staff of the Mount Sinai Jewish Center to apply topical over-the-counter creams (sunscreen/diaper cream) to my child according to label instructions.I hereby give my child permission to go on stroller walks in the neighborhood.I hereby give the Mount Sinai Jewish Center permission to use my child's photos for publicity purposes to help promote their program.I agree to be added to the Daycare WhatsApp group for daily updates, reminders, and photos. (phone number provided for Parent 1)

In addition, this must be filled out to keep on your child's file and must have original signature: OCFS-LDSS form.
Please email to daycare@mtsinaishul.com prior to start date.

Total Due Now (registration fee)

Mon, August 15 2022
18 Av 5782

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Mon, August 15 2022 18 Av 5782