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Gan-Gani Preschool Registration 2024-2025
Hours & Rates
Father
First Name
*
Last Name
*
Phone Number
*
Email
*
Gender
Female
Male
Street Address
*
City
*
Postal Code
*
State/Province
*
Background and additional info
Born to Jewish faith?
Yes
No
Converted to Judaism?
Yes
No
Employment
Occupation
*
Name of Business
Business Phone Number
Address of Business
Mother
First Name
*
Last Name
*
Phone Number
*
Email
*
Gender
Female
Male
Share address of
Parents are married
Marital Status
*
- Select -
Divorced
Separated
Street Address
*
City
*
Postal Code
*
State/Province
*
Kids living with?
*
- Select -
Father
Mother
Relationship to Father Relationship Type(s)
Spouse of
Partner of
Ex-Spouse of
Background and additional info
Born to Jewish faith?
Yes
No
Converted to Judaism?
Yes
No
Employment
Occupation
*
Name of Business
Business Phone Number
Address of Business
How many kids do you want to apply for?
*
1
2
3
4
Child 1
First Name
*
Last Name
*
Nickname
Hebrew Name
Example: David or דוד
Gender
*
- Select -
Female
Male
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
address
- None -
Child live with the Father
Child live with the Mother
Background and additional info
Adopted?
Yes
No
Born to Jewish faith?
Yes
No
Converted to Judaism?
Yes
No
Class entering
*
- Select -
Elsa's Place (9 to 18 months)
Shorashim (18 months - 2 Years)
Alim (2 - 3 Years)
Nitzanim (3 - 4 Years)
Pericha (4 - 5 Years)
Month and year child will enter
Medical History
Does the child have a chronic illness?
*
Yes
No
receiving medication on a regular basis?
*
Yes
No
Does the child have allergies?
*
Yes
No
Allergy details
*
Please list any information that may directly affect the safe care or medical treatment of your child
Snack & Supply fee Child 1
*
- Select -
5 Days a week - $625
3 Days a week - $525
2 Days a week - $425
Child 2
First Name
*
Last Name
*
Nickname
Hebrew Name
Example: David or דוד
Gender
*
- Select -
Female
Male
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
address
- None -
Child live with the Father
Child live with the Mother
Background and additional info
Adopted?
Yes
No
Born to Jewish faith?
Yes
No
Converted to Judaism?
Yes
No
Class entering
*
- Select -
Elsa's Place (9 to 18 months)
Shorashim (18 months - 2 Years)
Alim (2 - 3 Years)
Nitzanim (3 - 4 Years)
Pericha (4 - 5 Years)
Month and year child will enter
Medical History
Does the child have a chronic illness?
*
Yes
No
receiving medication on a regular basis?
*
Yes
No
Does the child have allergies?
*
Yes
No
Allergy details
*
Please list any information that may directly affect the safe care or medical treatment of your child
Snack & Supply fee Child 2
*
- Select -
5 Days a week - $625
3 Days a week - $525
2 Days a week - $425
Child 3
First Name
*
Last Name
*
Nickname
Hebrew Name
Example: David or דוד
Gender
*
- Select -
Female
Male
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
address
- None -
Child live with the Father
Child live with the Mother
Background and additional info
Adopted?
Yes
No
Born to Jewish faith?
Yes
No
Converted to Judaism?
Yes
No
Class entering
*
- Select -
Elsa's Place (9 to 18 months)
Shorashim (18 months - 2 Years)
Alim (2 - 3 Years)
Nitzanim (3 - 4 Years)
Pericha (4 - 5 Years)
Month and year child will enter
Medical History
Does the child have a chronic illness?
*
Yes
No
receiving medication on a regular basis?
*
Yes
No
Does the child have allergies?
*
Yes
No
Allergy details
*
Please list any information that may directly affect the safe care or medical treatment of your child
Snack & Supply fee Child 3
*
- Select -
5 Days a week - $625
3 Days a week - $525
2 Days a week - $425
Child 4
First Name
*
Last Name
*
Nickname
Hebrew Name
Example: David or דוד
Gender
*
- Select -
Female
Male
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
address
- None -
Child live with the Father
Child live with the Mother
Background and additional info
Adopted?
Yes
No
Born to Jewish faith?
Yes
No
Converted to Judaism?
Yes
No
Class entering
*
- Select -
Elsa's Place (9 to 18 months)
Shorashim (18 months - 2 Years)
Alim (2 - 3 Years)
Nitzanim (3 - 4 Years)
Pericha (4 - 5 Years)
Month and year child will enter
Medical History
Does the child have a chronic illness?
*
Yes
No
receiving medication on a regular basis?
*
Yes
No
Does the child have allergies?
*
Yes
No
Allergy details
*
Please list any information that may directly affect the safe care or medical treatment of your child
Snack & Supply fee Child 4
*
- Select -
5 Days a week - $625
3 Days a week - $525
2 Days a week - $425
Emergency Contact 1
First Name
*
Last Name
*
Phone Number
*
Relationship to the kids
Emergency Contact 2
First Name
*
Last Name
*
Phone Number
*
Relationship to the kids
Authorization for Emergency Medical Care
In the event my child becomes ill or is injured at school or while under the supervision of the school, I hereby authorize any employee or representative of Gan Gani Preschool to obtain medical aid for my child. I have been advised by the school that it will exercise such authorization when I cannot be contacted in time. I acknowledge that charges for such medical care will be my responsibility and not that of Gan Gani Preschool.
Doctor’s Full Name
*
Office Phone Number
*
Address
*
City
*
State
*
Zip
*
Preferred Hospital
Hospital Location/Address
Emergency Room Phone Number
Signature of Parent
*
Registration + Snack & Supply Fee Child #1
$
Registration + Snack & Supply Fee Child #2
$
Registration + Snack & Supply Fee Child #3
$
Registration + Snack & Supply Fee Child #4
$
Discount Code
Discount
$
Chabad Center for Jewish Life & Learning
info@chabadsa.com
|
210-764-0300
|
14535 Blanco Rd.
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