Religious School Deposit

First Name of Parent Filling Out Form

Last Name of Parent Filling Out Form

* Number of Children Registering

* Address

* City

* Zip

Child #1 Registration

* Name of Child, First and Last

* DOB

* Grade your child will be in Sep. 2020

* Name of Public/Private Day School your child will be in Sep. 2020

* Emergency Contact Name

* Relationship to Child

* Emergency Contact Phone #

* Alternate Phone Number for Emergency Contact

* List all known allergies: Enter NONE if no known allergies

* Does your child have an IEP or 504? If no enter NONE.

* Does your child has any visual, auditory or other issues of which we should be aware? Enter NONE if there aren't any.

* Deposit For:

Child #2 Registration

* Name of Child, First and Last

* Date of Birth

* Grade your child will be in Sep. 2020

* Name of Public/Private Day School your child will be in Sep. 2020

* Emergency Contact Name

* Relationship to Child

* Emergency Contact Phone #

Alternate Phone Emergency Contact

* List all known allergies: Enter NONE if no known allergies

* Does your child have an IEP or 504? If none enter NONE

* Does your child has any visual, auditory or other issues of which we should be aware? Enter NONE if there aren't any.

* Early Bird Deposit For:

Child #3 Registration

* Name of Child, First and Last

* Date of Birth

* Grade your child will be in Sep. 2020

* Name of Public/Private Day School your child will be in Sep. 2020

* Emergency Contact Name

* Relationship to Child

* Emergency Contact #

* Alternate Emergency Contact Phone

* List all known allergies: Enter NONE if no known allergies

* Does your child have an IEP or 504 if no enter NONE

* Does your child has any visual, auditory or other issues of which we should be aware? Enter NONE if there aren't any.

* Deposit For:

Child #4 Registration

* Name of Child, First and Last

* Date of Birth

* Grade your child will be in Sep. 2020

* Name of Public/Private Day School your child will be in Sep. 2020

* Emergency Contact Name

* Relationship to Child

* Emergency Contact Phone#

* Alternate Phone Number Emergency Contact

* List all known allergies: Enter NONE if no known allergies

* Does your child have an IEP or 504? If no enter NONE

* Does your child has any visual, auditory or other issues of which we should be aware? If NO enter NONE

* Early Bird Deposit For:

Total

Thu, February 27 2020 2 Adar 5780