The Gan Yeladim Registration 2024/2025

Registration Form - 2024/2025
Preschool Grounded in Jewish Values & Inspired by Montessori
1. Student Information
Name*

First Name Last Name
Hebrew Name
Birth Date*

Month Day Year
Hebrew Birthday
Previous School Attended*

Name & Number
Student´s age in the summer*
Is The Applicant Adopted?*

YesNo
Was The Applicant Converted?*

YesNo
Food and/or Drug Allergies:
Is This Child Currently Taking Prescribed Medication?*

YesNo
If Yes, Please List The Medications & The Reason For Taking
Are There Any Problems That Restrict This Child's Activities?*

YesNo
If Yes, Please Explain
Primary Language Spoken At Home*
Synagogue Affiliation
2. Parents Information

Father
Name*

First Name Last Name
Hebrew Name
Cell*

Area Code Phone Number
E-mail*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Best Method Of Contact*
Employer*

Name & Phone Number
3. Parents Information

Mother
Name*

First Name Last Name
Hebrew Name
Cell*

Area Code Phone Number
E-mail*

Address (If different from above)

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Employer*

Name and Phone Number
Best Method Of Contact*
4. Emergency Information
Emergency Contact #1*

First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
Emergency Contact #2*

First Name Last Name
Phone Number*

Area Code Phone Number
Relationship*
Pediatrician*
Phone Number*

Area Code Phone Number
Insurance*
Policy #*
Emergency Permission*

I give The Gan Yeladim permission to administer medical care to my child in the case of emergency, G-d forbid. In the event that we are unable to reach either emergency contact, The Gan will act in the best interest of the child, to seek appropriate medical attention as needed.I will provide a copy of current immunization status
Photo - The Gan likes to celebrate student work and achievements on our website, social media, newsletters, and other multimedia.

I give The Gan Yeladim permission to photograph and videotape my children and use the photos and videos (without their names) for our website, social media, newsletters, and other multimedia as necessary.
School Directory - The Gan Family Directory is distributed to The Gan families to support connections within the community. It is exclusively for noncommercial use. Please indicate below your inclusion preferences.*

YES you may include our family in The Gan Yeladim Family Directory.No, I do not want to include our family in The Gan Yeladim Family Directory
Field Trips*

I give my child permission to attend all field trips.I would be willing to carpoolI do not give my child permission to attend field trips
5. Pick up Authorization

The person picking up your child will be required to present his/her photo ID. Under no circumstances will a child be released to a person who has NOT been authorized by the parent. This is for the protection and safety of your child.
Please list all authorized persons:*
6. Payment
Registration Fee $425.00 (per child)*

$425
Total

$0.00

Payment*

Credit Card Other

Postal / Zip Code

Country

Should be Empty:

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Registration Form - 2024/2025

1. Student Information

2. Parents Information

3. Parents Information

4. Emergency Information

5. Pick up Authorization

6. Payment