Club Isaiah After School Registration 2026-27

Club Isaiah After School Registration 2026-27

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Registration Fee

$150 per child

Parent / Guardian Information

Parent 1 First Name

Parent 1 Last Name

Parent 1 Email

Parent 1 Phone Number

Additional Parent / Guardian (optional)

Parent 2 First Name

Parent 2 Last Name

Parent 2 Email

Parent 2 Phone Number

Household Information

Street Address

Unit / Apt #

City

State

Zip Code

Child Information

Registration Fee

Fee

Child First Name

Child Last Name

Date of Birth (MM/DD/YYYY)

Grade for 2026-2027

School Name

Does your child have any medical or other needs (e.g. allergies, neurodiverse needs)? Checking YES will invite a follow-up conversation

YESNO

How many days per week would you like to attend (can change later)?

Which days per week would you like to attend (can change later)?

MondaysTuesdaysWednesdaysThursdaysFridays

Will your child require transportation from school to Temple Isaiah?

YESNO

Is there anyone at your child's school that you'd like to refer to our program?

YESNO

Additional Name(s)/Contact information

Questions / Comments

Please share any questions or additional notes here. Thank you!

Payment Information

Amount

$

US Dollars

Name on Card

Card Number

MM

YY

Code

Address Line 1

Address Line 2

City

State

Postal Code

Country

Billing Email

Authnet_Hidden_Fields

Are you a Temple Isaiah Member?

YesNo but interested in joiningNo

Contact Information