Name *

First Name

Last Name

Phone *

(###)

###

####

Address *

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Name *

First Name

Last Name

Birth Date *

MM

DD

YYYY

Has your child ever participated in any Sunday School, Hebrew School, or Non-day School Jewish Educational program? *

Jewish Day School

Hebrew School/Sunday School

Online Classes

Private Tutor

None, till now.

Other

Does your child read basic Hebrew? *

We are trying to gauge what level your children are at. This is no indication that your child must know hebrew.

Yes

No

Know's the letters

Is your child potty trained? *

Yes

Yes, with a reminder

No, not yet

Do you give the Friendship Circle permission to change your childs diaper during our care? *

For safety there will be 2 people present at all time.

Yes, I give permission and will leave diaper, wipes, & gloves, and any other necessary materials to change my child

No, I do not give permission. I will stay in the parent room or near the location in case my child needs to be changed.

N/A