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New Enrollment

We’re so excited about your interest in having your child join The Gan!

We’d be happy to schedule a school tour and answer any questions you may have.

Please allow about 15 minutes to complete your application form below. Once submitted, your student account will be set up to begin the enrollment process.

If you have any questions at any stage, please feel free to reach out to us at Rabbi@ChabadKirkland.com.

We look forward to welcoming you and your family to The Gan!
1. Student info
Full Name*
First Name Last Name
Gender*

MaleFemale
is your child adopted?*

YesNo
Is your child born yet?*

YesNo
Date of Birth / Expected Due Date

Month Day Year
We'd love to learn about your child! Please share some of his/her unique strengths, interests and personality*
Past Education (please list name of schools, addresses, phone numbers, grade level completed, dates and two references per school)
Previous/ current preschool, Daycare, Mommy & Me classes:*
Has your child ever been dismissed from a school? *

YesNo
Jewish Community / Synagogue Affiliation?*
How did you hear about us?*
What interests you about our school/programs?*
2. Parents / Guardian info:
Father / Guardian 1*
First Name Last Name
Father/ Guardian 1 E-mail*
Father / Guardian 1 Phone number*

Father / Guardian 1 Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Is father Jewish by birth or choice?*

By BirthBy ChoiceConvertedNot Jewish
Mother / Guardian 2:*
First Name Last Name
Mother / Guardian 2 E-mail:*
Mother / Guardian 2 Phone Number*

Mother/ Guardian 2 Address If other than parent 1

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Is Mother Jewish by birth or choice?*

By BirthBy ChoiceConvertedNot Jewish
If converted, by whom?*
3. Medical & Emergency
Additional Emergency Contact:*
First Name Last Name
Phone Number*
Relationship to Student *

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Additional Persons Authorized to Care for Child*
First Name Last Name
Relationship:*
List of adults authorized to pick up and drop off student to/from The Gan
Primary Physician or Medical Facility*
Provider Phone Number*

Provider Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Medical Insurance info:*
I hereby give my consent for emergency medical treatment, to be used only if I cannot be reached immediately.*
My child is up to date with the MMR vaccine.*

YesNo
Please upload Certificate of Immunization Status (CIS)
List any illnesses your child had within past 6 months**
List any Sensitivities your child has. Any dislikes you feel we should be aware of?**
Does your child have any allergies?*

YesNo
If yes, Please describe bellow
Please describe any instructions that would be helpful in caring or for your child, or special medical information needed by the child’s care staff/provider
Does your child have a history of

Physical handicapsRheumatic feverHeart problemsSeizuresAsthmaDiabetesNo
4. Program:
When would you like to join:

Month Day Year
2025-26 School year, Sep 2, 2025 to June 25, 2026*

Half day Program - Infant room -$17,000Half day program Toddler room - $15,000Full Day Program - Infant room - $19,000Full day program - Toddler room - $17,500
Payment options 25/26 Post-dated checks, OR payments on your credit card, must be submitted with this contract, All credit card payments are subject to a 3% processing fee.

1 Time payment4 Equal payments8 Equal Monthly payments
2026-27 School year, Sep 1, 2026 to June 23, 2027*

Half day Program - Infant room -$17,000Half day program Toddler room - $15,000Full Day Program - Infant room - $19,000Full day program - Toddler room - $17,500
Payment options 26/27 Post-dated checks, OR payments on your credit card, must be submitted with this contract, All credit card payments are subject to a 3% processing fee.

1 Time payment, Sep 1, 20264 Equal payments, Sep, Nov, Jan, March8 Equal Monthly payments, Sep- April
A non-refundable registration fee of $250 and a deposit of half a month’s tuition is due at the time of enrollment.
Total

$0.00

Payment

Credit Card Paypal Other

Postal / Zip Code

Country

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1. Student info

2. Parents / Guardian info:

3. Medical & Emergency

4. Program:

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