BaGeL Family Program Registration
Full Name (Parent 1)
*
First Name
Last Name
Email (Parent 1)
*
example@example.com
Phone Number (Parent 1)
*
Please enter a valid phone number.
Address (Parent 1)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Would you like to add a second adult?
*
Yes
No
Name (Parent 2)
*
First Name
Last Name
Email (Parent 2)
*
example@example.com
Phone Number (Parent 2)
*
Please enter a valid phone number.
Address (Parent 2)
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
How many children in your family are in grades TK-2nd?
*
1
2
3
Full Name (Child 1)
*
First Name
Last Name
Date of Birth (Child 1)
*
-
Month
-
Day
Year
Date
Grade (Child 1)
*
TK
Kindergarten
1st Grade
2nd Grade
School Name (Child 1)
*
Full Name (Child 2)
*
First Name
Last Name
Date of Birth (Child 2)
*
-
Month
-
Day
Year
Date
Grade (Child 2)
*
TK
Kindergarten
1st Grade
2nd Grade
School Name (Child 2)
*
Full Name (Child 3)
*
First Name
Last Name
Date of Birth (Child 3)
*
-
Month
-
Day
Year
Date
Grade (Child 3)
*
TK
Kindergarten
1st Grade
2nd Grade
School Name (Child 3)
*
Do you have any children in your family that are younger than TK-age?
*
Yes
No
What is/are their name(s) and age(s)?
*
Do you have any children in your family that are in grades 3rd and up?
*
Yes
No
What is/are their name(s) and age(s)?
*
Does anyone in your family have allergies or medical conditions we should know about?
*
Yes
No
Please explain:
*
Full Name (Emergency Contact)
*
First Name
Last Name
Phone Number (Emergency Contact)
*
Please enter a valid phone number.
Relationship to Family (Emergency Contact)
*
Virtual Image Policy
The Shomrei Torah Synagogue and Temple Aliyah websites, their print publications, and social media are tools to communicate with synagogue families families, students, teachers, prospective families and students, and the larger Jewish community. To enhance this experience, we use photos and videos to show student involvement in various JLC activities. On rare occasions, we will invite the local media to our campus to cover an event, and your child's picture may be taken. At no time are any child’s names associated with a photograph. Please feel free to contact Rabbi Adam at rabbiadam@templealiyah.org or Natalie Horwitz at nhorwitz@stsonline.org should you have any questions.
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