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Shabbat kids program registration

Child's Name*
First NameLast Name
Hebrew Name*
Birth Date*
MonthDayYear
Jewish Birthday
School*
Grade entering*
Child #2 Name
First NameLast Name
Hebrew Name
Birth Date
MonthDayYear
Jewish Birthday
Grade entering
School
Additional notable Information
Parents email*
Birth Date
MonthDayYear
Payment
$32 for one month $192 for 6 months
Registration Fee
$32 CAD$192 CAD
Total
$0.00 CAD

Payment

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Postal / Zip Code

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