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Parent's name
*
Parent contact number
*
Email address
Number of children attending: Members
None
1 ($10)
2 ($20)
3 ($30)
4 ($40)
5 ($50)
6 ($60)
Number of children attending: Non-members
None
1 ($20)
2 ($40)
3 ($60)
4 ($80)
5 ($100)
6 ($120)
Names and Grades of ALL child(ren) attending (eg: Mia- K, Shalom- 4)
I acknowledge that I will not send anyone to the program if he/she or a member of their household is sick:
I agree
I disagree
Total payment
Thu, May 2 2024 24 Nisan 5784