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Gan ATC Registration

Person Filling out Form
Student Information
Parent/Guardian Information
Emergency Contact Information

Please list the name and contact information for 2 emergency contacts below. 
Please list name and phone number.
Please list name and phone number.
Medical Information

It is essential for our Religious School to have the following information to serve your child. This information is held to the strictest confidence and for office use only.
Please list your child's pediatrician and phone number.
IE. allergies, asthma, epilepsy, glasses, heart issues, hearing issues, etc.
Please specify if your child is served by Chapter 766.
Photography 
This is an application for the registration of my child to Talmud Torah the Ahavath Torah Congregation's South Area Religious School. It is our understanding that this is merely an application and registration is not completed until the Financial Secretary of Ahavath Torah Congregation has certified that all financial requirements of the Congregation have been satisfied.

I hereby authorize Ahavath Torah Congregation to contact my child's Pediatrician, in the event I cannot be reached and such a call is necessary. Should the Pediatrician not be reached, I authorize the contact to another physician or Emergency Services.                              

 
Thu, January 2 2025 2 Tevet 5785