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Netivot Shalom Preschool Toddler Program Application

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All fields are required. Write N/A if not applicable. 
Child's Information
Parent/Guardian #1 Information
Parent/Guardian #2 Information
General Information
Schedule Choices

*Currently enrolling in Spring 2025 for 8 am-1 pm or 3:30 pm. Care to 4:30 pm in Summer Fun and care to 5:30 during the regular school year is pending Licensing approval. Final care hours will be determined by August 2025.

Extended Care Choices

*Care past 1 pm is pending and will be available based on Licensing Approval. Final care hours will be determined by August 2025. 

Health Questions
NOTE: ShulCloud payments made by ECheck (No Service Fee) or pay with a Credit Card (3% Fee).
Fri, April 18 2025 20 Nisan 5785