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Beachside Montessori Hebrew Enrichm0ent Club Registration - Session 2

Registration for Session 2 closes on Friday, November 27th, 2026
How many kids attending? *
Student 1 Name
First Name Last Name
Student 1 Birth Date

Month Day Year
Student 1 Grade
Student 1 Teacher's Name
First Name Last Name
Does Student 1 have any allergies?

YesNo
If yes, please specify the allergies:
Student 2 Name
First Name Last Name
Student 2 Birth Date

Month Day Year
Student 2 Grade
Student 2 Teacher's Name in Beachside Montessori
First Name Last Name
Does Student 2 have any allergies?

YesNo
If yes, please specify the allergies:
Student 3 Name
First Name Last Name
Student 3 Birth Date

Month Day Year
Student 3 Grade
Student 3 Teacher's Name in Beachside Montessori
First Name Last Name
Does Student 3 have any allergies?

YesNo
If yes, please specify the allergies:
Method of Pick-up

AftercareASP
Mother's Name
First Name Last Name
Mother's Birth Date

Month Day Year
Mother's Phone Number
Mother's E-mail
Father's Name
First Name Last Name
Father'sBirth Date

Month Day Year
Father's Phone Number
Father's E-mail

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

I hereby give permission for my child/children to be photographed while participating in Beachside Montessori Village Hebrew Club

YesNo
Pay in Full Amount for 1 StudentPay in Full Amount for 2 StudentsPay in Full Amount for 3 StudentsPay in 3 Installments for 1 StudentPay in 3 Installments for 2 StudentsPay in 3 Installments for 3 Students
Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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