West Side Family Center, Inc.
63 West 92nd Street
New York, N. Y. 10025Email: westsidefamilypreschool@gmail.com
www.westsidefamilypreschool.comPhone: 212-316-2424
Admission‘s Application for the month 2010/2011/2012
Child’s Name_____________________ D.O.B.______ M/f
Home Phone # ( )____-_____Daytime # ( )____-_______________________
Nickname:____________ Place of Birth______________
Are both parents living?______ Married? ________Separated?___________ Divorce________Other______ explain________________________________
With whom does the child live? Parents_______________________________
Guardian________________________________________________________
Parent’s Name____________________ Occupation_____________________
Name and Address of Business______________________________________
Work ( ) _____-_________ Cell ( )____________Beeper ( ) ___________
Parent’s Name___________________ Occupation______________________
Name and Address of Business______________________________________
Work( )_______-________Cell( )______-_______Beeper ( )________
Email Parents #1______________________#2__________________________
Siblings?___ _______Names and ages__________________________________
Languages spoken at home__________________________________________
Attended other programs? _______________Which one(s)________________
Please complete this form and mail application with fee of $35 check or money order. Call to make an appointment for one hour and half visit for you and your children
This will allow you to experience the total school environment. It is an excellent opportunity to meet the staff and perhaps other parents. Resumes of Staff members are available upon request We also have a list of current and former parents if you wish to contact them by phone or email. This admission process helps you decide if this program meets your concerns and your child’s needs.
Completed application and fee must be paid as a requirement for your classroom visit.
Date / __/___
Parent’s Signature(s) __________________
Elaine Rosner-Jeria, Director
Rev.11/10