Holy Chag! Registration - LIFE AT HOLY BLOSSOM

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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