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Kosher Chefs Registration

Kosher Chefs Registration

Kosher Chefs
Registration Form

2016-2017

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: $125 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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