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Gan Avraham Preschool Application
336 Euclid Avenue, Oakland, California 94610
You MUST Submit before leaving this form or ALL entries will be lost.
Child
Enter the child's
full
name (example: use Joseph not Joe)
First name
*
Middle names
Last name
*
Preferred name
🛈
Gender
*
Male
Female
Date of birth
*
+
Program request
Days per week
: How many days per week are you requesting to enroll your child?
Arrive and depart
: What times do you plan for your child to arrive and depart Gan Avraham
Requests are not guaranteed
Days per week
*
3
4
5
Arrive
*
8:00 am
8:30 am
9:00 am
Depart
*
1:00 pm
3:30 pm
5:30 pm, 4:30 pm on Friday
Parent or legal guardian
Title
*
🛈
First name
*
Last name
*
Relationship to child
*
Street address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Enter telephone numbers as 10 digits with no other characters
Primary telephone
*
Type
*
Home
Cell
Work
Other
Email address
*
Temple Beth Abraham
*
Member
Interested in becoming a member
None of the above
Member since
*
+
Second parent or legal guardian
All appropriate fields in this section must be completed in full if your child has a surviving second parent or legal guardian. Check below if your child does not have a surviving second parent or legal guardian.
No second parent
Child does not have a surviving second parent or legal guardian
Title
*
🛈
First name
*
Last name
*
Relationship to child
*
Second parent address
Same address as first parent
Street address
*
City
*
State
*
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
Zip Code
*
Enter telephone numbers as 10 digits with no other characters
Primary telephone
*
Type
*
Home
Cell
Work
Other
Email address
*
About your child
Previous child care
: Include family care, preschools, etc.
Previous child care facility or caregiver
*
Previous child care address
*
Previous child care telephone
From
+
To
+
Special needs
*
Enter the names of siblings and their birth dates.
Sibling name
Date of birth
+
Gan Avraham
Attended or will attend next fall
Sibling name
Date of birth
+
Gan Avraham
Attended or will attend next fall
Sibling name
Date of birth
+
Gan Avraham
Attended or will attend next fall
Parent or legal guardian signature
Electronic signature
*
Signature date
*
+