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Jewish Kids Club

Full Name*

First Name Last Name
E-mail
Phone Number

- Area Code Phone Number
Cost per child:
$18 per 2 week program
$72 for the full series.
Children Attending Chanukah Program:
Children Attending Tu B'shvat Program:
Children Attending Purim Program:
Children Attending Pesach Program:
Children Attending Shavuot Program:
Amount due:*

Payment

Credit Card

Credit Card Type
- Credit Card Number	Security Code

/ Expiration Month Expiration Year

Should be Empty:

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