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Waiting List

Waiting List

B’’H

GAN CHABAD OF THE MAIN LINE
EARLY LEARNING CENTER

WAITING LIST

Please wait to hear from our office as we review your application.

625 Montgomery Avenue, Merion Station, PA 19066
(610) 660-9900 * TEMMA@CHABADMAINLINE.ORG

Student's Information

Child's First Name:
Last Name:
D.O.B:
Address:
Mother (or Guardian Name):
Cell Phone:
Email:
Father (or Guardian Name)
Cell Phone:
Email:
Emergency Contact Person
Emergency Contact Number
Emergency Contact Person (2)
Emergency Contact Number (2)
Name of Child's Physician / Medical Care Provider:
Phone Number:
Marital Status:
Married: Separated Divorced
Other (Please Explain)

Additional programs we are interested in

Morning (8:00am)
Afternoon (1:00-2:30pm Enrichment)
Afternoon (1:00-2:30pm) Napping
Afternoon (2:30-4:00pm) Extended care
Allergies: Yes No If yes please explain
Registration Fee: $300 Check Credit Card
Card Type: Visa Master Card Amex
Card Number:
Expiration Date
Security Code:

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Upcoming events
May. 24, 2017
come with a partner or get set up with one to study while enjoying cholent and beer
Jun. 05, 2017
6:30 PM Hors D'ouevres | 7:30 Program​