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Programs Shabbat

Shabbat Kids Club Form

Shabbat Kids Club
Register your child for our Shabbat Kids Club for ages 3-8
How many kids are you registering?*
SELECT YOUR CLUB MEMBERSHIP
Option 1: $120/year

I can pay $120/per year ($10/month) in total.
Option 2: $120/year per child.

I can pay $120/per year ($10/month) for each of my children.
Option 2: $120/year per child.

I can pay $120/per year ($10/month) for each of my children.
Option 2: $120/year per child.

I can pay $120/per year ($10/month) for each of my children.
Option 2: $120/year per child.

4 Children5 Children6 Children
Option 3: Please select. I can donate the following:

$360/year ($30/month)$600/year ($50/month)$900/year ($75/month)$1200/year ($100/month)
Option 4: Sponsor a Shabbat. Our Shabbat programs costs $360/week
Please enter if you have a specific Shabbat Date/s you'd like to sponsor.
PARENT #1 INFO
Full Name*
First Name Last Name
E-mail*

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Phone Number*
PARENT #2 INFO
Full Name
First Name Last Name
E-mail
Phone Number
Child/Children's Information
Full Name
First Name Last Name
Age
Full Name
First Name Last Name
Age
Full Name
First Name Last Name
Age
PAYMENTS

Payment

Credit Card Paypal Venmo

Postal / Zip Code

Country

Total

$0.00
Yes, I'd like to make this a monthly recurring payment.
I would like to receive news and updates by email
Should be Empty:

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