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Permission Form

By filling out this form I give permission for my child, in grade 3 - 8, to join Hebrew School for an EXTENDED day on Sunday February 11, from 9:30 a.m. - 2:20 p.m.

Students will participate in an exciting
JEWQ Regional Competition
Pizza Party and
Dave & Busters Trip

Cost is $30
Child's Name*

First Name Last Name
Child's Grade*
Parent E-mail Address*
Cost*

$30
Total

$30.00

Payment

Credit Card

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

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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