Junior Shabbat Dinner - Camp Ohr Menachem

Full Name of the camper*
First Name Last Name
E-mail*
Phone Number*
Drop-off / Pick-up

I will pick up my daughter at Chabad CSLI will meet at the meeting point, 6872 Kildare

Address

Payment*

Credit Card

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

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