Gan HaYeled Application Form
The Gan has gone paperless! (Well, almost!) We've digitized most of the enrollment forms needed for the Gan. Please fill out this questionnaire completely. *THIS INFORMATION IS USED TO POPULATE EMERGENCY FORMS. PLEASE BE SURE ALL INFORMATION IS FILLED OUT AND CORRECT FOR ALL PRIMARY CAREGIVERS* If you have any questions, please contact Abby Koplow at abby.koplow@adasisrael.org or call 202-362-4491.

Before you begin, please be sure you have contact information (phone numbers, addresses, etc) for your family and emergency contacts and your child's health insurance information. You will need this information to complete the form. It will take you approximately 10-15 minutes to complete this form and you will not be able to save it to return to it later. Thank you for applying to the Gan!

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Which year are you applying for?
BASIC INFORMATION - CHILD
Child's First Name
Your answer
Child's Middle Name(s)
Your answer
Child's Last Name
Your answer
Child's Preferred Name
Your answer
Child's Birthdate
MM
/
DD
/
YYYY
Child's Gender
Child's Hebrew Name
Please include your child's Hebrew Name. If your child does not have a Hebrew name, please write "n/a"
Your answer
Child's Home Address
Number and Street
Your answer
Child's Home Address
City
Your answer
Child's Home Address
State
Your answer
Child's Home Address
Zip Code
Your answer
Is your child a continuing Gan student?
Is your child a sibling of a continuing Gan student or Alumni?
Please list the names and ages of other children in your family
Example: Mira Goldberg, 6 yrs
Your answer
Has your child attended another preschool before this year? If so, please list school name and location
Your answer
What languages are spoken in your home?
Please list all languages spoken regularly in your home
Your answer
Parent/Guardian 1 First Name
Your answer
Parent/Guardian 1 Last Name
Your answer
Parent/Guardian 1 Home Address
Your answer
Parent/Guardian 1 Home Address
City
Your answer
Parent/Guardian 1 Home Address
State
Your answer
Parent/Guardian 1 Home Address
Zip Code
Your answer
Parent/Guardian 1 Home Phone
(XXX)XXX-XXXX
Your answer
Parent/Guardian 1 Cell Phone
(XXX)XXX-XXXX
Your answer
P/G1: If you would like to receive emergency text alerts from the Gan to this cell number, please list your cell service provider
(Sprint, Verizon, T-Mobile, AT&T, etc) Text message fees from your provider will apply
Your answer
Parent/Guardian 1 Occupation/Position
Your answer
Parent/Guardian 1 Work Phone
(XXX)XXX-XXXX
Your answer
Parent/Guardian 1 Work Address
Please list employer and work address
Your answer
Parent/Guardian 1 Preferred Email
This email will receive all communications from the Gan, including emergency alerts
Your answer
Parent/Guardian 1 - Emergency Email
If you would like to add an additional email to receive emergency alerts ONLY, please add that address here
Your answer
Is Parent/Guardian 1 Jewish?
Parent 2 (If applicable) First Name
Your answer
Parent 2 (If applicable) Last Name
Your answer
Parent 2 (If applicable) Home Address
Your answer
Parent 2 (If applicable) Home Address
City
Your answer
Parent 2 (If applicable) Home Address
State
Your answer
Parent 2 (If applicable) Home Address
Zip Code
Your answer
Parent 2 (If applicable) Home Phone
(XXX)XXX-XXXX
Your answer
Parent 2 (If applicable) Cell Phone
(XXX)XXX-XXXX
Your answer
P2: If you would like to receive emergency text alerts from the Gan to this cell number, please list your cell service provider
(Sprint, Verizon, T-Mobile, AT&T, etc) Text message fees from your provider will apply
Your answer
Parent 2 (If applicable) Occupation/Position
Your answer
Parent 2 (If applicable) Work Phone
(XXX)XXX-XXXX
Your answer
Parent 2 (If applicable) Work Address
Please list employer and work address
Your answer
Parent 2 (If applicable) Preferred Email
Your answer
Parent 2 (If applicable) Emergency Email
If you would like to add an additional email to receive emergency alerts ONLY, please add that address here
Your answer
Is Parent 2 Jewish? (If applicable)
(If Applicable) Do both parents live with this child?
Are there other members of this household (grandparents, etc)?
If yes, please explain
Your answer
Are you members of Adas Israel
Required
Are you members of another synagogue (please name)
Your answer
Please check which program you are requesting:
If you are unsure which class to select, please check your PRIMARY choice and select "other" and provide more information.
OPTIONAL: Please provide an alternative cell number that should receive emergency text messages
e.g. nanny, grandparent, etc. Please be sure to confirm with the recipient that they want to receive these messages as text message fees will apply.
Your answer
Alt: Please provide the cell service provider for this additional cell number
(Sprint, Verizon, T-Mobile, AT&T, etc) Text message fees from your provider will apply
Your answer
What is the relationship of this person to your child? (for emergency text alerts)
e.g. nanny, grandparent, etc
Your answer
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