Jewish Kids Club Registration:

Child's Name

Age:

School:

Parents' Names:

Phone Number:

Emergency Number:

Sessions Attending: Chanukah Fun (Dec. 14)

                                 Kosher Hunt (Jan. 19)

                               Shabbat (Feb. 12)

                          Purim  (March 8)

                                             Surprise trip (April 26)

                                          Lag B'omer (May 12)

Method of Payment: Check         

                            Credit Card   

Credit Card #:

EXP:

Sec. Code: