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Mother
First Name
*
Last Name
*
Phone Number
*
Email
*
Street Address
*
City
*
Gender
Female
Male
Postal Code
*
State/Province
*
Jewish Status
*
- Select -
Born Jewish
Converted to Judaism
Not Jewish
Marital Status
*
- Select -
Married
Divorced
Single
Father
First Name
*
Last Name
*
Phone Number
*
Email
*
Share address of
Same address as above
Street Address
*
City
*
Postal Code
*
State/Province
*
Jewish Status
*
- Select -
Born Jewish
Converted to Judaism
Not Jewish
Relationship to Mother Relationship Type(s)
- None -
Child of
Parent of
Spouse of
Partner of
Sibling of
Supervised by
Supervisor
Yahrzeit observed by
Yahrzeit observed in memory of
Nephew/Niece of
Uncle/Aunt of
Grandchild of
Grandparent of
Cousin of
Child in law of
Parent in law of
Sibling in law of
Step child of
Step parent of
Great Nephew/Niece of
Great Uncle/Aunt of
Ex-Spouse of
Friend of
Other relation to
Gender
Female
Male
How many children do you want to register?
*
1
2
3
Child 1
First Name
*
Last Name
*
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
Grade
*
- Select -
Kindergarten
1
2
3
4
5
6
7
8
Participant Fee
$
Child 2
First Name
*
Last Name
*
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
Grade
*
- Select -
Kindergarten
1
2
3
4
5
6
7
8
Participant Fee
$
Child 3
First Name
*
Last Name
*
Birth Date
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Year
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
2021
2022
2023
2024
2025
2026
Grade
*
- Select -
Kindergarten
1
2
3
4
5
6
7
8
Participant Fee
$
Notes
Activity Subject
Interval of Installments
Discount code
Siblings discount
$
Discount
$
Payment Plan
*
Pay in full ($60 off per child)
Pay over 10 months
Chabad of Winter Garden
Office@JewishWinterGarden.com
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(407) 350-8665
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