Pre-School Interest Form

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* Family Last Name

* Todays date

Date to begin school

* Which are you interested in receiving information for?

Preschool School YearPreschool Summer CampPlease click all that apply.

* Address

* City

* State

* Zip Code

* How many students are being enrolled?

* Student 1 - First Name

* Student 1 - Last Name

Student 1 - Nickname

* Student 1 - Date of Birth

Student 1 - Gender

Student 2 - First name

Student 2 - Last name

Student 2 - Nickname

Student 2 - Date of Birth

Student 2 - Gender

Student 3 - First name

Student 3 - Last name

Student 3 - Nickname

Student 3 - Date of Birth

Student 3 - Gender

* Parent/Guardian 1 - First Name

* Parent/Guardian 1 - First Last

* Parent/Guardian 1 - Email

* Parent/Guardian 1 - Cell Phone

* Parent/Guardian 1 - Birthdate

* Are you and your family members at another synagogue?

YesNo

* If you are a member of another synagogue, please provide the synagogue name.

* Free membership at Beth El.

Yes, we are interested in receiving a free membership with Beth El as long as our oldest child is in your preschool.No, thank you for the offer but we do not wish to have a free membership at Beth El.

* Does your child have older siblings? If yes, please include their name and ages here. If none, please type None.

* Is there a second parent or guardian?

Parent/Guardian 2 - First Name

Parent/Guardian 2 - First Last

Parent/Guardian 2 - Email

Parent/Guardian 2 - Cell Phone

Parent/Guardian 2 - Birthdate

This field is REQUIRED if including 2nd parent.

* Does Parent 2 live at the same address as Parent 1?

Parent/Guardian 2 - Address

Parent/Guardian 2 - City

Parent/Guardian 2 - State

Parent/Guardian 2 - Zip Code

Sat, July 27 2024 21 Tammuz 5784