|
Contact Information
|
| Child(ren)sFull Name* |
|
|
Child(ren)s Age* |
|
|
ParentFirst Name*
|
|
|
State* |
|
|
Parent
LastName*
|
|
|
Zip* |
|
| Address* |
|
|
Phone |
|
| City* |
|
|
Email* |
|
| |
|
Suggested Donation:
$10 per child
Event Sponsor $180
Chabad of North Brooklyn's programs are funded thanks to our generous sponsors!
|
| $ (address above should match card billing address) |
| Card Type |
|
|
Exp. Date |
|
| Card Number |
|
|
CVV Code |
|
You may send checks to Chabad of North Brooklyn
132 North 5th St #2c, | Brooklyn, NY 11249 or bring cash or check to the party |
| Comments |
| |
| |
|
|
|
|
