2022-2023 Beth El Early Learning Center Application

PARENT 1 INFORMATION

Title

* First Name

* Last Name

Hebrew Name (if Jewish)

Please use English letters

Nickname

* Gender

* Email

* Cell Phone - Enter as: (xxx) xxx-xxxx

* Can we use your cell phone for texting services?

* Date of Birth

* Marital Status

If Married, Date of Marriage

HOME ADDRESS

* Street Address 1

Street Address 2

(Enter Apt #, Suite #, etc)

* City

* State

* Zip Code

Subdivision

Home Phone - Enter as: (xxx) xxx-xxxx

Please do NOT enter CELL #

* Is this HOME address the same as the BILLING Address?

BILLING ADDRESS

Billing Street Address 1

Billing Street Address 2

(Enter Apt #, Suite #, Etc)

Billing City

Billing State

Billing Zip Code

Billing Phone - Enter as: (xxx) xxx-xxxx

BUSINESS INFORMATION

* Are you Retired?

* Occupation

* Employer Name

Business Phone

Business Email

RELIGIOUS BACKGROUND

* Religious Background

Non-Jewish Denomination

PARENT 2 INFORMATION

Title

First Name

Last Name

Date of Birth

Hebrew Name (if Jewish)

Please use English letters

Nickname

Gender

Email Address

(Please use a different email address than specified for Parent 1)

Cell Phone - Enter as: (xxx) xxx-xxxx

Can we use your cell phone for texting services?

Is home address for Parent 2 same as for Parent 1 ?

HOME ADDRESS (Parent 2)

Street Address 1

Street Address 2

City

State

Zip Code

Subdivision

Home Phone - Enter as: (xxx) xxx-xxxx

Please do NOT enter CELL #

RELIGIOUS BACKGROUND

Religious Background

Non-Jewish Denomination

BUSINESS INFORMATION

* Are you Retired?

* Occupation

* Employer Name

Business Phone

Business Email

ENROLLMENT and CHILDREN INFORMATION

Temple Beth El Family Membership is included with your enrollment.

Click here for tuition prices.

*
How many children do you plan to enroll in our program?

* Child-1 First name

* Child-1 Last name

* Child-1 Date of birth

* Child-1 Gender

* Schedule options for Child-1

* Child-2 First name

* Child-2 Last name

* Child-2 Date of birth

* Child-2 Gender

* Schedule options for Child-2

* Child-3 First name

* Child-3 Last name

* Child-3 Date of birth

* Child-3 Gender

* Schedule options for Child-3

* Child-4 First name

* Child-4 Last name

* Child-4 Date of birth

* Child-4 Gender

* Schedule options for Child-4

ADDITIONAL CHILDREN INFORMATION

If you have any children living in your household, other than the child(ren) you are currently applying for, please list their information by clicking on the BLUE "+" (plus sign) below.
*** Click the BLUE "+" (plus sign) each time to enter each child

Child's First Name

Child's Last Name

Gender

Child's Hebrew Name (if applicable)

Date of Birth

Bar/Bat Mitzvah Date

Grade 2023-2024 School Year

Name of School

In order to keep your child engaged and informed regarding Temple activities, please provide the following information:

Child's Mobile Phone - (xxx) xxx-xxxx

Child's Email Address

Have any of your child's older siblings attended the Beth El Early Learning Center in the past?

If YES, please list their names below

First Name

Last Name

First Name

Last Name

First Name

Last Name

Have any of your children ever attended our Summer Adventure Camp in the past?

If YES, please list their names below

First Name

Last Name

First Name

Last Name

First Name

Last Name

OTHER PEOPLE IN HOUSEHOLD

* Other than your children and yourselves, does anyone else reside in your household?

If YES, please list their names below

First Name

Last Name

Relationship to you

First Name

Last Name

Relationship to you

TEMPLE MEMBERSHIP

Please tell us how you found us?

* Are you or your spouse related to any current Temple Beth El members?

First Name

Last Name

Relationship

First Name

Last Name

Relationship

First Name

Last Name

Relationship

* Have you ever been members of TEMPLE BETH EL in the past?

* Have you belonged to any other synagogue during the past 24 months?

* Name of synagogue

* Do you or your spouse have any relatives who are current members of TEMPLE BETH EL?

Example: Parents, grandparents, aunts, uncles, cousins, etc
If so, please list their names below

First Name

Last Name

Relationship

First Name

Last Name

Relationship

First Name

Last Name

Relationship

COMMENTS

Is there anything else you would like to share with us?

* Parent 1 - Please sign your application electronically (Full Name) here:

Parent 2-Please sign your application electronically (Full Name) here:

Thu, April 18 2024
10 Nisan 5784

Upcoming Programs & Events

Apr

Brotherhood Pre-Passover Brunch
Sunday, Apr 21 10:00am

Apr

Passover Second Night Seder
Tuesday, Apr 23 5:30pm

Apr

Sisterhood: Women's Passover Experience - "Soldier On" by Bracha Horovitz
Thursday, Apr 25 7:00pm

May

Mussar and Movement
Thursday, May 2 6:30pm

May

Filmmakers for the Prosecution Film Screening
Thursday, May 2 7:00pm

Erev Passover

Monday, Apr 22

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Thu, April 18 2024 10 Nisan 5784