Jewish Enrichment Club

Child #1
First Name
Last Name
Hebrew Name
Gender
DOB
School
Grade Entering (Sept. 2018)
Jewish Enrichment Club Dates November 4November 11 November 18
Child #2
First Name
Last Name
Hebrew Name
Gender
DOB
School
Grade Entering (Sept. 2018)
Jewish Enrichment Club Dates November 4 November 11 November 18

 

Parent Information
Father's Name
Mother's Name
Address
City, State, Zip
Phone
Cell Phone Mother

  
E-mail mother
Cell Phone Father
E-mail Address Father

 

Payment
Fee is $10.00 per a class 
Name on Card:
Card Type
Card Number
Exp. Date
CCV Number (on back of card)
Comments (optional)