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Shabbaton

Shabbaton in Crown Heights, June 22 - 16 Sivan Weekend
Child's Name

Please submit a separate form for each child
Last Name
Gender

BoyGirl
Age

9101112
Parent contact number
Parent E-mail

Address for pick up and drop off

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Does your child have any allergies
shabbaton cost $25 per child*

$25

Payment

Credit Card Other E.g., Check, Cash

Postal / Zip Code

Country

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