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Jewish Kids Club Registration

Jewish Kids Club Registration

Jewish Kids Club
Registration Form

2017-2018

General Information
Child Name Hebrew Name
Child Name Hebrew Name
Child Name Hebrew Name
Address Phone
City/State/Zip Email  
Parents Information
Mothers Name Fathers Name
Mothers Email Fathers Email
Emergency Information
Emergency Contact Phone
Allergies    
Billing Details: $120 Per Child for year, $15 Per Session
$ Card Type*
First Name Last Name
Card Number* Expiration Date*
CVV* (Check if same as address)
Billing Address
Comments  

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