Pre-Registration Request Chai Club After School Hebrew Program 21/22

CHAI CLUB

AFTER SCHOOL HEBREW PROGRAM
20350 NE 26th Avenue, Miami, FL, 33180

Pre-Registration Request
Fall Session: September-December
Spring Session: January-June

Important note: By completing this form, you acknowledge that you are submitting a pre-registration request to the program. Registration will open soon and you will be notified via email once it opens, at which time you will have to complete the formal registration process and submit the required documents.
Registration will be accepted on first-come, first-serve basis. Limited capacity per group applies.

* School Student/s Attending

All pre-registration requests are subject to space availability.

PARENT/GUARDIAN # 1

Parent/Guardian # 1 Title

* Parent/Guardian # 1 First Name

* Parent/Guardian # 1 Last Name

* Parent/Guardian # 1 Address

* Parent/Guardian # 1 City

* Parent/Guardian # 1 State

* Parent/Guardian # 1 Zip

* Parent/Guardian # 1 Cell Phone

Parent/Guardian # 1 Work Phone

* Parent/Guardian # 1 E-mail

PARENT/GUARDIAN # 2

Parent/Guardian # 2 Title

Parent/Guardian # 2 First Name

Parent/Guardian # 2 Last Name

Parent/Guardian # 2 Address

Parent/Guardian # 2 City

Parent/Guardian # 2 State

Parent/Guardian # 2 Zip

Parent/Guardian # 2 Cell Phone

Parent/Guardian # 2 Work Phone

Parent/Guardian # 2 E-mail

* How many children do you intend to pre-register for the Chai Club?

* Student # 1 First Name

* Student # 1 Last Name

* Student # 1 Date of Birth

* Student # 1 Grade Level as of September 2021

* I'm requesting a pre registration for the following term

Fall session September- DecemberSpring Session January- JuneFull Year 2021-2022

Please complete the following

Student 1 Homeroom Teacher

Student 1 Room Number

* Student 1 Id #

* Student 1 First and Last Name

* Student # 2 First Name

* Student # 2 Last Name

* Student # 2 Date of Birth

* Student # 2 Grade Level as of September 2021

* I'm requesting a pre registration for the following term

Fall session September- DecemberSpring session January- JuneFull year 2021- 2022

Please complete the following

Student 2 Homeroom Teacher

Student 2 Room Number

* Student 2 Id #

Student 2 First and Last Name

* Student # 3 First Name

* Student # 3 Last Name

* Student # 3 Date of Birth

* Student # 3 Grade Level as of September 2021

* I'm requesting a pre registration for the following term

Fall 2021 September - DecemberSpring session 2021-2022 January- JuneFull Year 2021-2022

Please complete the following

Student 3 Homeroom Teacher

Student 3 Room Number

* Student 3 Id #

Student 3 First and Last Name

* Please type your full name below to acknowledge you have read and agree to comply with the Beth Torah Adath Yeshurun, Inc.-Chai Club pre-registration conditions set forth above.

Sat, January 22 2022 20 Shevat 5782