Temple Tots Registration 2022

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* Enrollment Type

Please Select OneCurrent Member - Pay per sessionCurrent Member - 5 Session Pass ($40)Non-Member - Pay per sessionNon-Member - 5 Session Pass ($50)Please select Membership Category and Payment Category. (5-session pass, or pay per session).
5-session pass will be handled by manual correction of registrations.

Adult First Name

Adult Last Name

* First Name - Child 1

* Last Name - Child 1

* Birth Date - Child 1

* List any Physical Conditions, Specific Learning Needs, Allergies/Special Dietary Needs//Medications for Student 1

List anything that might be important for teacher and staff to know.
If student doesn't have any allergies, special dietary needs or medications, please enter "None" in the box above.

Contact information for adult registering and attending with child(ren).

* Information already on file?

Please Select OneNOYESHave you registered a child before?
If not, please enter appropriate contact information.

* Name

Adult First Name

* Name

Adult Last Name

* Adult 1 - Home Phone Number

* Adult 1 - Cell Phone Number

* Adult 1 - Email Address

Adult 2 Name

Adult 2 - Home Phone Number

Adult 2 - Cell Phone Number

Adult 2 - Email Address

* Emergency Contact Name 1

* Emergency Contact 1 Relationship to Child(ren)

* Emergency Contact 1 Phone Number

Emergency Contact Name 2

Emergency Contact 2 Relationship to Child(ren)

Emergency Contact 2 Phone

Physician Name

Physician Phone Number

* Registration - Member

Select session(s) you wish to sign up for.
You may use this form multiple times as the year progresses.

Registration - Non Member

Select session(s) you wish to sign up for.
You may use this form multiple times as the year progresses.

Registration - Batch of 5 sessions

Select up to 5 session(s) you wish to sign up for.
You may use this form multiple times as the year progresses.

Tuition Total

TOTAL AMOUNT DUE. You may pay online or charge to your account if you are logged in.

Wed, April 24 2024 16 Nisan 5784

Temple Tots Registration 2022

CONGREGATION KOL HAVERIM