High Holiday Childcare Registration 5785/2024

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REGISTRATION

* Adult 1 Name:

* Mobile:

Email:

Address:

Adult 2 Name:

Mobile:

* Email:

* Address:

* Child 1 Name:

* Birthdate:

* List child's allergies, if any?

CHILD NUMBER 1

Rosh Hashanah Day 1 - Thursday, October 3 - 10:00 am - 12:00 pm child 1Rosh Hashanah Day 2 - Friday, October 4 - 10:00 am - 12:00 pm child 1Yom Kippur Day - Saturday, October 12 - 10:00 am - 12:00 pm child 1Sign up for child #1.

Child 2 Name:

Birthdate:

List child #2's allergies, if any?

CHILD NUMBER 2

Rosh Hashanah Day 1 - Thursday, October 3 - 10:00 am - 12:00 pm child 2Rosh Hashanah Day 2 - Friday October 4 - 10:00 am - 12:00 pm child 2Yom Kippur Day - Saturday, October 12 - 10:00 am - 12:00 pm child 2Sign up for child #2.

Child 3 Name:

Birthdate:

List child # 3's allergies, if any?

CHILD NUMBER 3

Rosh Hashanah Day 1 - Thursday, October 3 - 10:00 am - 12:00 pm child 3Rosh Hashanah Day 3 - Friday, October 4 - 10:00 am - 12:00 pm child 3Yom Kippur Day - Saturday, October 12 - 10:00 am - 12:00pm - child 3Sign up for child #3.

Total

Total Amount Owed

Any questions? Contact Stacy Ybarra at 847.498.4100, ext. 115, or via email at SYbarra@BethShalomNB.org.

Sat, September 7 2024
4 Elul 5784

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Sat, September 7 2024 4 Elul 5784