Application Form
Program Info
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Child Information
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Child 1
Gender
 
Date of Birth
 
General Information
Program
Hours
 
Days
 
Days
 
Extended Care
 
Days
 
Days
 
Days
 
General
Would you like your child to be on our lunch program?
 
Child 2
Gender
 
Date of Birth
 
General Information
Program
Hours
 
Days
 
Days
 
Extended Care
 
Days
 
Days
 
Days
 
General
Would you like your child to be on our lunch program?
 
Child 3
Gender
 
Date of Birth
 
General Information
Program
Hours
 
Days
 
Days
 
Extended Care
 
Days
 
Days
 
Days
 
General
Would you like your child to be on our lunch program?
 
Child 4
Gender
 
Date of Birth
 
General Information
Program
Hours
 
Days
 
Days
 
Extended Care
 
Days
 
Days
 
Days
 
General
Would you like your child to be on our lunch program?
 
Child 5
Gender
 
Date of Birth
 
General Information
Program
Hours
 
Days
 
Days
 
Extended Care
 
Days
 
Days
 
Days
 
General
Would you like your child to be on our lunch program?
 
 
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Parents Info
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Mother
Business Address
Father
Business Address
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Contact Info
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Address
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Family Info
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Siblings
Sibling 1
Sibling 2
Sibling 3
Sibling 4
Sibling 5
Sibling 6
Sibling 7
Sibling 8
Sibling 9
 
General
Is the Mother of the Child Jewish?
 
Is the Father of the Child Jewish?
 
Are there any conversions in the family?
 
Are you affiliated with a synagogue?
 
Does the child live with both natural parents?
 
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Additional Information
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I allow my name/email address to be included in a school or class directory
 
I allow photos of my child to be posted on Facebook and Instagram
 
How did you hear about us?
 
Comments
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Payment Information
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Summary
Payment
Tuition Payments
 
Payment Options
 
Credit Card
Expiry Date
 
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