Temple Tots

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REGISTRATION FORM - REGISTER ONCE OR MULTIPLE TIMES.

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* Enrollment Type

Current Member - Pay per sessionCurrent Member - 5 Session PassNon-Member - Pay per sessionNon-Member - 5 Session PassPlease 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.

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.

Tuition Total

Fri, October 30 2020 12 Cheshvan 5781