Children's Programs Registration - Chabad of Southern Oregon

Parent's Name

First NameLast Name

Phone Number

Area CodePhone Number

E-mail

Address

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

I am registering for:

1 Child2 Children3 Children

Child 1:

First NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemale

Child 2:

First NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemale

Child 3:

First NameLast Name

Birth Date

MonthDayYear

Gender

MaleFemale

We will be attending the following Rosh Hashana Programs*Check all that apply. Free of Charge, Donation appreciated!

Jewish Discovery Hour - Rosh Hashana Edition - Sept.14 - Full Registration belowRosh Hashana Puppet Show on Zoom - Sept. 15Shofar Family Service in Lithia Park with Busy the Bee- Sept. 20

We'd like to pick up a fun package for our children to do on Rosh Hashana

YES

Suggested Donation $10 per program

I'm interested in my children attending Jewish Discovery Hour Fall SemesterWeekly from Sept. 14 - Dec. 7 Includes classes for High Holidays and Chanukah

Yes, On ZoomYes, In PersonOn the edge, I'd like more information about itI will pass for this semester

I'd like to register my child for Jewish Discovery Hour Fall Semester

Full Price: $300 per childScholarship amount: $180 per childI'm going through a financially difficult time and request a further scholarship.

Comments

Do any of your children attending have any allergies or dietary restrictions? If yes, please explain:

Does your child have any health issues that we need to know about? If yes, please explain:

Payment

Credit Card Paypal

Total

$0.00

CHILD INFORMATION