CHANUKAH PERFORMANCE

FRIEND RSVP:
This is a drop-off event. Ages 3-12.
Child's name*
First Name Last Name
Which HSA student invited you or how'd you hear about this?
Age*
Does your child have any allergies or other medical condition we should be aware of? If yes, please describe them and indicate special precautions or care needed.
Father's Name*
First Name Last Name
Father's E-mail*
Father's Cell*

Area Code Phone Number
Mother's Name*
First Name Last Name
Mother's E-mail*
Mother's Cell*

Area Code Phone Number
Mother's Religion *
Father's Religion*

Full Home Address where child resides*

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Expiration Month	Expiration Year

As the parent(s) or legal guardian of the above child, I/we authorize any adult acting on behalf of Chabad Hebrew School to hospitalize or secure treatment for my child. I hereby give permission for my child to participate in all school activities, join in class and school trips on and beyond school properties and allow my child to be photographed while participating in Chabad Hebrew School activities and that these pictures may be used for marketing purposes.*

I accept
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