MY ALEPH PRESCHOOL. | cvalley.chabadsuite.net

Mother's Info

First Name *

Last Name *

Hebrew Name *

Mobile Number *

Email *

Mother Is Jewish *

Yes

No

Are there any conversions or adoptions in the family? *

Yes

No

Please Explain *

Father's Info

First Name *

Last Name *

Hebrew Name *

Mobile Number *

Email *

Father Is Jewish *

Yes

No

Address

Street Address *

City *

Postal Code *

State/Province *

Country *

Emergency Contact

First Name *

Last Name *

Phone Number *

How many children would you like to register? *

Child 1

First Name *

Last Name *

Hebrew Name *

Gender *

Birth Date *

Month

Day

Year

Birth Date Before Sunset *

Yes

No

Relation to Emergency contact *

Physician's Name *

Physicians Phone Number *

Please list any Allergies or Medical concerns

Aleph Options (9:00 am - 1:00 pm) *

Full Week

Monday, Wednesday, Friday

Tuesday, Thursday

Additional Care

Early Care 8:00 - 9:00

After Care 1:00 - 4:00

Extended Care 4:00 - 6:00 (Mon - Thur only)

Child 2

First Name *

Last Name *

Hebrew Name *

Gender *

Birth Date *

Month

Day

Year

Birth Date Before Sunset *

Yes

No

Relation to Emergency contact *

Physician's Name *

Physicians Phone Number *

Please list any Allergies or Medical concerns

Aleph Options (9:00 am - 1:00 pm) *

Full Week

Monday, Wednesday, Friday

Tuesday, Thursday

Additional Care

Early Care 8:00 - 9:00

After Care 1:00 - 4:00

Extended Care 4:00 - 6:00 (Mon - Thur only)

Note

Registration Fee $