LIFE AT HOLY BLOSSOM
Jewish Service Network Day Trip
Kids Mitzvah Club
survey
HOLY CHAG! REGISTRATION
Child's Name
*
First
Last
Additional Name
*
First
Last
Additional Name
*
First
Last
Grade
*
Grade
*
Grade
*
Additional Name
*
First
Last
Grade
*
Parent's Name
*
First
Last
Phone Number
*
Email
*
Emergency Contact Name
*
Phone Number
*
Relationship
*
I agree to the statement below
*
Yes
No
I hereby permit my child/children to participate in the Holy Blossom Temple Holy Chag! program during the 2015-2016 fiscal year under supervision. I hereby release Holy Blossom and their employees and agents from all manner of cause of actions for personal injury, damage to property or otherwise, arising out of my child’s participation in an event.
Lisa Baumal will be in contact directly to discuss payment options.
Please us the button below to complete your registration.
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