Preschool Intake Form - Form - Peninsula Temple Sholom

Preschool Intake Form

* How many new Children are being registered?

* Child 1 - First Name

* Child 1 - Last Name

* Child 1 - Date of Birth

* Child 1 - Age of as Sept 2025

* Child 2 - First Name

* Child 2 - Last Name

* Child 2 - Date of Birth

* Child 2 - Age of as Sept 2025

* Child 3 - First Name

* Child 3 - Last Name

* Child 3 - Date of Birth

* Child 3 - Age of as Sept 2025

* Address

* City

* State

* Zip Code

* How many Adults live in the household?

* Adult 1 - First Name

* Adult 1 - Last Name

* Adult 1 - Email

* Adult 1 - Mobile Phone

* Adult 2 - First Name

* Adult 2 - Last Name

* Adult 2 - Email

* Adult 2 - Mobile Phone

Sun, June 15 2025 19 Sivan 5785

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