Toddler Class Registration 2024-2025/5785

* Student First Name

Middle Name

* Last Name

* Date of Birth

* Register for Eitz Chayim's toddler class

Total:

If this cost is preventative, please let us know.

One adult will remain with Toddler during class from 10-11:15am.

* How many adults are there in your household?

Parent Information

Parent #1

* First Name

* Last Name

* Cell Phone

Home Phone

* Email address

Parent #2

First Name

Last Name

Cell Phone

Home Phone

Medical Information

Allergies to food or medications

* My child uses an EPI-PEN to respond to allergic reactions

Medications

* If your child needs to take medications during school hours, please inform the School Director.

Any other medical information you consider significant

Are you a member of Congregation Eitz Chayim?

YesNo, another synagogueNo, unaffiliated with a synagogue

Synagogue affiliation:

Fri, October 11 2024 9 Tishrei 5785