30 West 68th Street | New York, NY 10023 | T: 212-877-4050 ext. 231 | F: 212-787-7108 |
[email protected] | swfs.org/ecc
Seeds of Wonder Registration Form January 8 - May 23, 2019 Child’s First and Last Name: ______________________________________Gender:_______ Date of Birth: _____________ Full Address: ________________________________________________________________ ___________________________________________________________________________ Parent Name ________________________________________________________________ Home number: _____________________Work number: ______________________________ Cell number: _______________________Email_____________________________________ Parent Name ________________________________________________________________ Home number: _____________________Work number: ______________________________ Cell number: _______________________Email_____________________________________ Caregiver Name______________________________________________________________ Home number: _______________________Cell number: _____________________________ Synagogue Member? Yes or No I am interested in having my child attend the Seeds of Wonder Program:
Synagogue Member Non-Member
$1,575 $1,925
Please enclose your full tuition. Signature: _______________________________ Date: ________________________ Please return with a $40 registration fee to: Stephen Wise ECC Attn: Vicki Reiss 30 West 68th St. New York, NY 10023 For questions, please contact Vicki Reiss at
[email protected] or 212-877-4050, ext. 231. If you are not a current ECC family, how did you hear about us? _____________________________