Director: Sara Leba Kozlov
1966 East 21st street, Brooklyn NY,11229
To register, please print and mail the completed form to the above address.
Registration form
Parents’ Name: ____________________________________
____________________________________
Father’s occupation:____________________________________
Mother’s occupation:____________________________________
Student’s Name: ___________________ Gender ________
Date of birth ___/___/_____
Home Phone: ______________________________________
Street Address _____________________________________________________
City, State, Zip Code __________________________________
Please select: ______ Part time (9:00 – 1:00) Tuition fee: $450 per month
______ Full time ( 9:00 – 3:00) Tuition fee: $600 per month
Friday dismissal 12:00 o’clock for both groups.
Please include a 100 dollar deposit with the registration form.
A one time fee of $100 will be charged in January to replenish the necessary nursery supplies.
Signature __________________________________ Date ____/_____/______