Form Test Wisdom Garden Registration 2023-24, Grade 3-6 "*" indicates required fields StudentStudent's name* First Last Hebrew name (if they have one) Hebrew name Grade* Birthdate* MM slash DD slash YYYY Allergies Parent 1Name – Parent 1* First Last Address – Parent 1* Address City State ZIP / Postal Code Cell Phone – Parent 1*Email – Parent -1* Preferred Means of communication: please check one or both* Text Email Parent 2Name – Parent 2 First Last Address – Parent 2 Address City State ZIP / Postal Code Cell Phone – Parent 2Email – Parent -2 Preferred Means of communication: please check one or both Text Email Emergency ContactName – Emergency Contact 1* First Last Relationship* PhoneName – Emergency Contact 2* First Last Relationship* Phone*TuitionTuition for Members: $350 | Non-Members: $450Tuition*Schoarship Fund DonationTotal Check Amount*Proposed Payment Date* MM slash DD slash YYYY No one turned away for financial reasons. Please call Ayala at 541-292-0805 if you need to make financial arrangements. Please remit to the Havurah office, or mail in to: Havurah Synagogue P.O. Box 1262 Ashland, OR 97520 Or email to: Ayala@ashlandhavurah.org NameThis field is for validation purposes and should be left unchanged. Δ
Form Test
Wisdom Garden Registration 2023-24, Grade 3-6
"*" indicates required fields