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Child Care Request for High Holidays 2018
Please answer applicable questions below regarding your child care needs.
Family Name *
Your answer
Home Phone Number
Your answer
Cell Phone Number *
Your answer
E-mail *
Your answer
Child Care is available for 1) Rosh Hashanah morning and 2) Yom Kippur morning
Child Care is available for children 2 years old through 2nd grade. Unfortunately, we cannot accommodate toddlers under 24 months of age. A fee of $15.00 per child per service is required. Child Care included crafts, games and snacks.

Please submit your form no later than September 1. Advanced registration is required and no refunds for unused care will be issued. We thank you in advance for your understanding and cooperation.

Child #1 Attending Child Care
Child's Name *
Your answer
Child's Age *
Your answer
Child's Grade *
Your answer
Days Attending *
Required
Child #2 Attending Child Care
Child's Name
Your answer
Child's Age
Your answer
Child's Grade
Your answer
Days Attending
Child #3 Attending Child Care
Third Child's Name
Your answer
Child's Age
Your answer
Child's Grade
Your answer
Days Attending
Amount Due *
Please mail your check for Child Care to Anshe Tikvah * P.O.Box 2455 * Northbrook, IL 60065-2455
Your answer
Name (parent or guardian) *
The listed parent or guardian, does hereby assume any and all responsibility arising out of the Child Care provided to the listed minors. I agree to remain at Stevenson High School so that I may be reached in case of an emergency. I agree to indemnify and hold harmless Anshe Tikvah, their agents, employees and servants from any liability related to Child Care and submit this consent freely and voluntarily.
Your answer
Date *
MM
/
DD
/
YYYY
Seat Location
To be provided upon arrival at Stevenson in case you need to be located during Services.
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