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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
The last JUDA Kids Club will take place on June 8th
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 $75 for the year

Child 1 $75Child 2 $75Child 3 $75Family $250
Amount $10 for individual session's

Child 1 $10Child 2 $10Child 3 $10Family $36
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