Gan Ilan New Family Intake Form

Welcome to the Gan Ilan Preschool new family form!

Thank you for answering these questions to help us get your account set up.

If you haven't already received an invitation to enroll, please call us at (925) 284-8453 to set up a tour and do not complete this form.

To complete your Gan Ilan registration:

1. Fill out this intake form.

2. You will receive an email the next business day from Salesforce inviting you to our member portal.

3. Register your child into the appropriate class.

Questions? Please contact the Temple office at (925) 283-8575.

ADULT #1:

First Name of Primary Contact Person In This Household *

Last Name *

Email Address of Adult #1 *

Cell Phone for Adult #1 *

HOME ADDRESS:

Street *

City *

State *

Zip Code *

Main Contact Number: *

ADULT #2 :

First Name of Adult #2

Last Name of Adult #2

Email Address of Adult #2

Cell Phone of Adult #2

CHILDREN:

First Name of Child Enrolling in Gan Ilan *

Last Name *

Birthdate of Child *

Gender *

Female

Male

First Name of 2nd Child Enrolling in Gan Ilan

Last Name

Birthdate of Child

Gender

Female

Male

First Name of 3rd Child Enrolling in Gan Ilan

Last Name

Birthdate of Child

Gender

Female

Male