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Chai Daycare Register Form

  • Registration 2018-2019 

  • 1. Child's Information

  • 2. Parent/Guardian Information

  • 3. What hours are you interested in?

  • We cannot guarantee your preferred dates. Remember, we can best provide for those who are flexible.

  • Pick a Date
  • * Please note that if there will be a fee if there will be any changes made to the schedule above.

    An additional $75 will be charged to anyone who changes their child's schedule before the first week of school. A $150 fee will be charged after the first week of school. 

    Changes will be made upon the school's discretion.  


  • 4. Pick Up

  • 5. Family Information

  • 6. Emergency Contact Information

  • Please indicate telephone numbers where you and another authorized person can be contacted in case of emergency.

  • 7. Child's Health Care Information

  • 7. Emergency Care

  • In case of an emergency, I authorize the staff to provide any First Aid care deemed necessary for my child.

    In case of an emergency in which I cannot be reached, the pediatrician listed above and the local hospital are hereby authorized to provide any emergency care deemed necessary for my child. 

    In case of emergency, I hereby authorize the transfer of my child's records to the local hospital.  

  • I hereby agree to the above and give my permission to care for my child in case of emergency, including medical care or first aid; transfer of care to my child's pediatrician or local hospital and health records transfer. 

  • Pick a Date
  • 8. Permission for Trips

  • I give permission to my son/daughter to participate in supervised curricular and extracurricular activities that may include leaving the daycare building.

  • Pick a Date
  • 9. Permission for Pictures

  • Pick a Date
  • I will not hire any staff member as a personal babysitter or in any other capacity.

  • Pick a Date
  • I have reviewed the guidelines and I hereby register my child 2018– 2019 school year.

  • Pick a Date
  • 10. Payment Information

  • A $206 non-refundable registration fee applies as part of this registration.

  • Credit Card
  •  Chai Day Care Office:
    569 Vanderbilt Ave. Brooklyn, NY 11238

    Please make checks payable to Chai.
  • Should be Empty:
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