Child Care Registration

MELBOURNE'S JEWISH LEARNING PROGRAM

All child care must be pre-booked and pre-paid by December 12th 2014

* Indicates required field

Child Care Registration Form 2014

Parent/Guardian *

First

Last

Mobile Number *

Email *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Who is attending Summer Learning Experience *

Father Mother Both

Download and email/fax form here

Child 1 Name *

CRN Number *

Child Date of Birth *

Program Attending *

Child 2 name *

CRN Number *

Date of Birth *

Program Attending *

Child 3 Name *

CRN Number *

Date of Birth *

Program Attending *

Days *

Full 7 days Daily (Please specify amounts of days)

Number of Days Attending *

Any known medical or allergy conditions? Please specify in detail *

Child/ren Doctor? *

Emergency Contact Name *

First

Last

Emergency Contact Number *

For additional children please fill in an ADDITIONAL form

Payment Details *

Once specified you will be contact with payment options
Child/Children will not be accepted unless paid prior to Summer Learning Experience.

Submit

All child care must be pre-booked and pre-paid by December 12th 2014