Child's First Name:
Child's Jewish Name:
Child's Last Name:
Date of Birth *mm/dd/yyyy
Home Phone Number:
I would like to register my child for:
Days & Tuition:
February 3 - June 8, 2020
MONDAYS AND THURSDAYS (February 3 - June 8, 2020): 9:30 am - 11:30 am - $990
MONDAYS ONLY (February 3 - June 8, 2020): 9:30 am - 11:30 am - $540
THURSDAYS ONLY (February 6 - June 4, 2020): 9:30 am - 11:30 am - $540
Known Food Allergies - Please list all food allergies.
What is your current synagogue affiliation?
Have been there any adoptions or conversions in the family? Please explain.
Does your child have siblings? Please list all siblings, their age and school they attend.
What is your child's previous school, group or camp experience (if any)?
Does your child receive any special services? i.e.: Speech, OT, PT, SEIT, etc. Please be specific.
Are there any special circumstances which we should know?
I allow my child's photograph to be used for promotional materials, website and facebook page.