Nehar Shalom Family Learning Registration 2021-2022
We are so excited to play and learn with you and your family this year! Please take a few minutes to fill out this form so we can get to know your family before our programs begin.


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Correo electrónico *
First and Last Name of the parent/guardian (adult 1) completing this form: *
Adult 1's pronouns: *
Adult 1 cell phone number *
Adult 1 Mailing Address *
If your family has a second adult, please list their first and last name, as well as their preferred pronouns, here. (If none, please write "N/A." If there are additional adults in your family, please put their names and pronouns here as well.) *
Email addresses for other adults in your household:
Cell phone number(s) for other adults in your household.
Mailing Address for other adult(s) in your household (if different than adult 1's)
In case of emergency, if we cannot reach the people previously listed, please provide the name, relationship and cell phone number of 1 or 2 trusted people to call. *
Nehar Shalom may use photos taken of my children during family education programs for the website or other promotional materials: *
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