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Limmud Centre Registration 2019-2020
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* Indicates required question
Email
*
Your email
Child's Full Name
*
Your answer
Child's Age
*
Your answer
Child Date of Birth
*
MM
/
DD
/
YYYY
Mother's Full Name
*
Your answer
Cell Number
*
Your answer
Email Address
*
Your answer
Father's Full Name
*
Your answer
Cell #
*
Your answer
Email Address
*
Your answer
Home phone number
*
Your answer
Home Address
*
Your answer
Does your child have any Allergies?
*
Yes ( Please explain below)
No
Your answer
Does your child have any medical concerns?
*
Your answer
Does your child take any medication?
*
Your answer
In order to complete your registration, a non-refundable deposit of $100 per child is required by June 24th, 2019.
*
I agree
Required
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