SHABBAT AFTERNOON YOUTH CENTER

Please fill out the form below to sign your child(ren) up for the 2022-2023 UPPER WEST SIDE SHABBAT AFTERNOON YOUTH CENTER. You may also use this form to sponsor this program.

Please reach out with any questions you may have.

PARENT/GUARDIAN INFORMATION

* First Name

* Last Name

* Phone

* Email

* Relationship

Other Guardian First Name

Other Guardian Last Name

Other Phone

Other Email

Other Relationship

Home Address

* What shul are you affiliated with?

CHILD(REN) INFORMATION

PLEASE LIST EACH PARTICIPANT INDIVIDUALLY
- CLICK THE PLUS ICON BELOW FOR EACH NAME YOU ARE ADDING.

* First Name

* Last Name

* Grade

* School

* D.O..B.

Phone

FEES & SPONSORSHIPS

* SELECT REGISTRATION LEVEL (FEB/MARCH)

ADDITIONAL SPONSORSHIP (enter an amount)

Note: Sponsorships of $1800 and above include family registration.

Total Due

Fri, April 19 2024 11 Nisan 5784

West Side Institutional Synagogue • 120 West 76th Street • New York, NY 10023
Tel: 212-877-7652 • Fax: 212-877-9333 • Email: office@wsisny.org