Teva means Nature Session 2: Akiba registration form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

December 8 - January 29

Tue/Wed (1-2pm) OR Thurs/Fri (9:30-10:30am)

12/8-12/9 12/10-12/11
12/15-12/16 12/17-12/18
1/5-1/6 1/7-1/8
1/12-1/13 1/14-1/15
1/19-1/20 1/21-1/22
1/26-1/27 1/28-1/29

Class will meet on Tuesdays from 1:00-2:00 pm at Harold Washington Park (across the street from Akiba) and on Wednesdays virtually from 1:30-2:00 pm. The other class will meet on Thursdays from 9:30-10:30 am at Harold Washington Park (across the street from Akiba) and on Fridays virtually from 10:00-10:30 am. We will abide by this schedule as much as possible unless we need to pivot because of weather.

Cost: $500 per family

Are you a current family or new to Akiba?

Current Akiba Family

New to Akiba

Clear selection

Parent(s) Name:

Parent 1 Email:

Parent 2 Email:

Parent 1 Phone Number:

Parent 2 Phone Number:

Student 1 Name and Date of Birth:

Student 2 Name and Date of Birth:

Student 3 Name and Date of Birth:

Name of parent/caregiver that will be attending:

Contact information for parent/caregiver that will be attending (please be sure to provide both cell phone and email address):

I would like to enroll for the following program:

Tuesdays and Wednesday, 1:00 - 2:00 pm, from December 8 - January 27

Thursdays and Fridays, 9:30 - 10:30 am, from December 10 - January 29

Clear selection

Cost is $500/family:

Roll over my 2020 - 2021 school year deposit to apply to this program.

I do NOT have a FACTS account. Please contact me for credit card payment.

Please charge my FACTS account.

Clear selection

Questions and comments for Carla Goldberg:

Print your name below to confirm that you will abide by the Akiba Social Contract and perform the daily health assessment before attending the program.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of Akiba-Schechter Jewish Day School. Report Abuse

Forms