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* Pre-K K 1 2 3 4 5 6 7 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 Pre-K K 1 2 3 4 5 6 7 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 Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other 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 Credit Card Paypal Venmo Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card 1 - January 2 - February 3 - March 4 - April 5 - May 6 - June 7 - July 8 - August 9 - September 10 - October 11 - November 12 - December Expiration Month 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 Expiration Year Paypal has been selected. Payment will take place on the next page. @JewishGV Billing Address Street Address Street Address Line 2 City State / Province Postal / Zip Code Please Select United States Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe Other Country Submit Should be Empty: This page uses TLS encryption to keep your data secure.