Child #1 Information Full Name* First Name Last Name Hebrew Name Grade* Pre-KK1234567 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 Would you like to register another child? YesNo Child #2 Information Full Name First Name Last Name Hebrew Name Grade Pre-KK1234567 Date of Birth Month Day Year Parents Information Mother Full Name* First Name Last Name Occupation E-mail* Cell Number* Area Code Phone Number Father Full Name* First Name Last Name Occupation E-mail* Cell Number* Area Code Phone Number 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 More Information Which other youth programming would you like to hear more about? Virtual Hebrew Reading Lessons, 1-on-1 on zoomJew-Q international Torah Championship (3rd-7th grade.)The Gan Coop (Preschool) for children 5 and underPre-Shabbat Musical Mommy & Me with Miriam for children 0-4Camp Gan IzzyShabbat & Holiday Programs for kidsBar & Bat Mitzvah TrainingChabad Teen Club! How did you hear about us? What is your main reason for choosing to sign up for this club?* Payment Information Sliding Scale 80% - 100% of the cost per child. We believe no child should be denied access to Jewish education and community due to financial situation. We have therefore created an option for you to pay less than the cost if you can't afford the full amount. Please contribute the full amount if you have the resources to do so. This supports the sustainability of our programming, including making it possible for those families without the financial capacity to participate. 1st Child: What are you signing up for? Kosher Snacks and all materials included.* Ceramics with Yaelle (ages 5-8, Mar-April) 2nd child: What are you signing up for?* Ceramics with Yaelle (ages 5-8, Mar-April) Total Payment. You may enter a custom amount if you wish to pay an amount in between. $0.00 I would like to pay today:Full amount80% minimum: $0.00 $ Payment Credit Card Paypal Venmo or Zelle Credit Card We accept Visa, MasterCard, American Express, Discover Credit Card Number Security Code Name on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - December Expiration Month2025202620272028202920302031203220332034 Expiration YearPaypal has been selected. 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