Chanukah Marketplace Childcare Registration 2026
Register your children for supervised childcare and/or creative activities for Sunday, Nov 15 at Temple Israel of Hollywood.
Parent/Guardian Information
Parent/Guardian Name
*
First Name
Last Name
Mobile Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email Address
*
example@example.com
Children
Families with 4 or more children should email wotiohpres@gmail.com instead of using this form.
Child 1 Name
*
First Name
Last Name
Child 1 Age
*
Child 1 Allergies
Child 1 Medical Considerations
Child 1 Accommodations / Special Needs
Child 2 Name
First Name
Last Name
Child 2 Age
Child 2 Allergies
Child 2 Medical Considerations
Child 2 Accommodations / Special Needs
Child 3 Name
First Name
Last Name
Child 3 Age
Child 3 Allergies
Child 3 Medical Considerations
Child 3 Accommodations / Special Needs
Program Interest
Which program option are you interested in?
*
Traditional supervised childcare
Holiday art project led by Creatiive Natiive
Both
Not sure yet
Which children will participate in which option?
*
Anticipated arrival time
*
Hour Minutes
AM
PM
AM/PM Option
Anticipated departure time
*
Hour Minutes
AM
PM
AM/PM Option
Emergency Contact
Emergency Contact Name
*
First Name
Last Name
Relationship to Child/Family
*
Please Select
Relative
Friend
Neighbor
Family Friend
Other
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Authorized Pickup Adults / Additional Instructions
Authorized pickup adults
Additional instructions or notes
Guardian Acknowledgement
Typed Name
*
First Name
Last Name
Date
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Register
Should be Empty: