Beth Jacob Hebrew School 2023-2024 Registration Form (Pre - School)
Child's Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Child Age
Child Nickname (If there's any)
Gender
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
# 1 Parent/Guardian Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
# 2 Parent/Guardian Name
First Name
Last Name
Email
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Who would you like to be the main contact
First Parent/ Guardian
Second Parent/ Guardian
Both
Other
Emergency Contact Name (In case we can't reach you)
First Name
Last Name
Relationship
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Any Allergies or Medical Conditions?
Yes
No
Please give details
Is your child toilet trained?
Yes
No
Can your child feed itself?
Yes
No
Does your child ask for assistance?
Yes
No
Does your child separate easily from you?
Yes
No
What activities you child enjoy?
Describe how your child show his/her feelings
is there additional information about your child's early learning behaviours and experiences/family situation, that your child's teacher/principal should know that you would like to share or have concerns about?
Do you want to add something about your child?
Please upload a profile picture of the child
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I, undersigned, agree with the following statements:
I am the parent/guardian of the child indicated above.
If emergency medical care is needed and I am unavailable, I authorize the supervising teacher to seek medical treatment for my child.
I am giving my permission to take my child's pictures for classroom projects and post them on the class app.
I am giving my permission to take my child's pictures for classroom projects and post them on the Beth Jacob website
I understand that Hebrew School one time fee will be paid before the beginning of the school year.
Date
-
Month
-
Day
Year
Date
Signature
Submit
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