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 2026

* Child 2 - First Name

* Child 2 - Last Name

* Child 2 - Date of Birth

* Child 2 - Age of as Sept 2026

* Child 3 - First Name

* Child 3 - Last Name

* Child 3 - Date of Birth

* Child 3 - Age of as Sept 2026

* 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

Tue, February 17 2026 30 Sh'vat 5786

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