Shaarei Shomayim After School Programs Fall 2019

Click the image below to view larger, and scroll down to fill out the form.

* Mother's First Name

* Mother's Surname

* Address

Apt/Unit

* City

* Postal Code

* Mother's Email

* Mother's Cell Phone

* Father's First Name

* Father's Surname

* Father's Email

* Father's Cell Phone

* Name(s) of Child(ren)

PLEASE LIST 1 NAME PER LINE.

* Child(ren) Date(s) of Birth

PLEASE LIST ONE PER LINE.

Please check if your child suffers from allergies.

Please check if your child uses an Epipen.

Please list any allergies with an explanation, if necessary.

Members: LEGO Creation $180

Non-Members: LEGO Creation $210

Members: Art Campp $280

Non-Members: Art Campp $325

Members: Kinder Science $175

Non-Members: Kinder Science $205

Total

Mon, 27 January 2020 1 Shevat 5780