Flagstaff Jewish Youth Registration

Participant's Name(Required)

Hebrew Name

Birthdate(Required)

Public School Grade

Allergies

Food Sensitivities

Flagstaff Jewish Youth Program(Required)

Torah Tots (2-5)

Bonim (6-9)

Kadimah (10-12)

Parent Name(Required)

Parent Hebrew Name

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Phone(Required)

Email Address(Required)

Additional Comments

Program Dues

No child and/or family will be turned away due to financial hardship. Please contact our treasurer to make arrangements at treasurer@levshalomaz.org

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