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Students Full Name 

Address 

City                 Zip 

Dad's e-mail 

Mom's e-mail 

Dad's Cell Phone  

Mom's Cell Phone 

Are Both Parents born Jewish 

Was there a Conversion in the Family? If So Who Converted?   

Age of Student  What Grade did he/she Just Complete 

Which School does your child attend 

How did you hear about our Sunday School 

Credit Card #

EXP 

By filling in the box below with my name, I agree to pay $100 a month per Student