Gan Shalom Preliminary Application Form

  
2048 Edgewater Ct.
Lexington, KY  40502
Phone: (859) 335-9922
Fax:     (859) 268-3357

Date:
Child's Name:
Date of Birth:
Home Address:
email: 
Phone Number: 
Parents' Information:
Father's Name
Father's Phone
Father's E-Mail
Mother's Name
Mother's Phone
Mother's E-Mail

Are you a member of Ohavay Zion Synagogue?

Indicate Programs that you are interested in:

Program Full-Time (8AM-5:30PM) Lunch & Fun (8AM-1PM)
Full 5-Day Week
3-Days (MWF)
2-Days (TuTh)

 

Concerns, questions, or comments?
   

A Registration fee will be required upon acceptance.