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Sundayprogramapplication

This document is a Shaping Lives Sunday Program application form requesting information about a child, their parents, siblings, and any relevant medical information. It asks for the child's name, date of birth, grade, address, school, and home phone number. It also requests the parents' names and cell phone numbers. Sibling information is collected including whether any also attend the program or can help the child study at home. Photo permissions and a suggested $40 monthly donation are mentioned. Emergency contacts are provided if there are any questions.

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100 views1 page

Sundayprogramapplication

This document is a Shaping Lives Sunday Program application form requesting information about a child, their parents, siblings, and any relevant medical information. It asks for the child's name, date of birth, grade, address, school, and home phone number. It also requests the parents' names and cell phone numbers. Sibling information is collected including whether any also attend the program or can help the child study at home. Photo permissions and a suggested $40 monthly donation are mentioned. Emergency contacts are provided if there are any questions.

Uploaded by

api-294258668
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Shaping Lives Sunday Program Application

Childs Information

________________________________
First Name

______________________________________
Last Name

________________________________
Date of Birth

_____________________________
Grade

Full Address
School Attending (Mention of Public or Yeshiva if not clear by the name)
_________________________________
Home Phone Number
Parents Information
___________________________________
Fathers First Name

______________________________________
Fathers Last Name

___________________________________
Mothers First Name

______________________________________
Mothers Last Name

___________________________________
Fathers Cell Phone
Sibling Information

______________________________________
Mothers Cell Phone

Do any siblings also go to our program? If yes, please write name(s) below
______________________________________________________________________________
______________________________________________________________________________
Do any siblings know Hebrew or go to yeshiva and are able to help your children study at
home? Yes/No
If yes, please state the age of the(se) sibling(s)_______________________________________
Please circle yes or no to allow use of photos to be used for promotional purposes such as
flyers or tzedaka boxes only:
Yes
No
The suggested donation (tax deductible so request a receipt if needed) is $40 a month to keep
the program running and pay for the materials, pizza, prizes, books, teachers etc. or please ask
for a tzedaka box!
Does your child have any allergies? __________________________________________
If you have any questions call:
Moisey Rafailov 347 553 5964 or,
Daniel Gadayev 917 705 1818

Thank you

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