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Gan Izzy Club Application Form
Do you want to keep the Gan Izzy spirit alive all year long? Join the Gan Izzy Club!

The freshest and most exciting events empower children to tap into their talents and interests while connecting to their Jewish identity!

7 events throughout the year (usually on a Sunday morning, before a Jewish holiday)

*Children 6 and above can attend without a parent.
*Children ages 3-5 should attend with a parent/adult. 1 to 3 ratio. We can do a rotation or I can see if teens are available to help with this. Sign up and then we'll iron out the details of this.
Child #1 Information
Full Name*

First Name Last Name
Hebrew Name
Entering Grade*
Date of Birth*

Month Day Year
My Child* Hebrew Reading is not necessary to join the Gan Izzy Club

Does Not Read HebrewRecognizes letters of the Alef-BetCan read Hebrew slowlyCan read Hebrew very wellCan speak Hebrew
My Child’s knowledge of basic Judaism*

GoodFairVery minimal
Does your child have any allergies?
Would you like to register another child?

YesNo
Child #2 Information
Full Name

First Name Last Name
Hebrew Name
Entering Grade
Date of Birth

Month Day Year
My Child

Does Not Read HebrewRecognizes letters of the Alef-BetCan read Hebrew slowlyCan read Hebrew very wellCan speak Hebrew
My Child’s knowledge of basic Judaism

GoodFairVery minimal
Does your child have any allergies?
Family Information
Is the child's biological mother born to a Jewish mother?*

YesNo
Is the child's biological father born to a Jewish mother?*

YesNo
Have there been any conversions or adoptions in your family? *

YesNo
If yes, please explain
Address and Information

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Home Phone

Area Code Phone Number
Parents
Father
Full Name*

First Name Last Name
Occupation*
E-mail*
Cell Number*

Area Code Phone Number
Mother
Full Name*

First Name Last Name
Occupation*
E-mail*
Cell Number*

Area Code Phone Number
Emergency Contact

In case of emergency and the parents cannot be contacted please contact
Full Name*

First Name Last Name
Phone Number*

Area Code Phone Number
More Information
What is your main reason for choosing to sign up for the Gan Izzy Club?*
How did you hear about us?
Which youth programming would you like to hear more about?

Virtual Hebrew Reading Lessons, 1-on-1 every SundayJew-Q international Torah Championship, for children in 3rd-7th grade. We will provide all support necessary to help children make their way to NY for the Championship. Local trips also arranged for those who cant' travel to NYThe Gan Coop (Preschool) for children 5 and under
Payment Information
We believe no child should be denied access to Jewish education due to financial situation. Limited Scholarships Available. Please contact Chyena for more information.

$50 registration fee per family (waived before July 10)
$145 annually for 7 monthly clubs per child.
$25 gan izzy club sweatshirt (free for those who registered before Aug. 15)

Contact Chyena to arrange a payment plan if necessary.
Tuition Total*

$
Total Charged Now

$0.00

Payment

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Postal / Zip Code

Country

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Gan Izzy Club Application Form

Child #1 Information

Child #2 Information

Family Information

Address and Information

Parents

Father

Mother

Emergency Contact

More Information

Payment Information