Temple Tots

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REGISTRATION FORM - REGISTER ONCE OR MULTIPLE TIMES.

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Temple Tots programs will be offered IN-PERSON at Congregation Kol Haverim.

* Enrollment Type

Current MemberProspective MemberNon-MemberPlease select Membership Category.

* 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.

Do you want to register a 2nd student?

Please enter a separate registration form if the second child is older than 1.

First Name - Child 2

Last Name - Child 2

Birthdate - Child 2

Allergies/Special Dietary Needs/Medications - Child 2

List anything that might be important for teacher or 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?

NOYESHave you registered a child before?
If not, please enter appropriate contact information.

* 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.

Thu, July 7 2022 8 Tammuz 5782