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JUDA Hebrew School

Inspiring Jewish Pride and Identity in Jewish Children - the future of Judaism.

ב"ה

KIDS CLUB

Reservation Form
Parents Name*

First Name Last Name
Number of Children*
Childs Name*

First Name Last Name
Childs Age*
Childs Name

First Name Last Name
Childs Age
Childs Name

First Name Last Name
Childs Age
Childs Name

First Name Last Name
Childs Age
E-mail*
Phone Number*

Area Code Phone Number

Address*

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

Any Comments / special requirements
Amount $90 for the year

Child 1 $90Child 2 $90Child 3 $90Family $300
Amount $15 for 1 JUDA KIds Club Event

Child 1 $15Child 2 $15Child 3 $15Family $54
Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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Educate Your Child... Educate a Generation