Mommy & Me

PLEASE RESERVE YOUR SPOT IN ADVANCE. SPACE LIMITED.

17950 Military Trail
Boca Raton, FL 33496
561-241-6257

Parent's Name*

First Name Last Name

Address*

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

E-mail*

Phone #*

Child's Name*

Child's Birthdate*

Month Day Year

Child - Programs Previously Attended* Write NONE if not applicable

Please list ages of sibling(s) (not listed above) and the school(s) they attend? Write N/A if there are no siblings.*

As the parent or legal guardian of the above child I allow my child to be photographed while participating in Tot Shabbat and that these pictures may be used for marketing purposes.*

YesNo

Payments can be made via Zelle [email protected]
or at
halperintorahtots.com/makepayment (3.12% non-cash processing charge for credit card, no fee for ACH or debit cards)

Class Options You can mark more than 1

Total

$0.00

How will you be paying?

Zelle - [email protected]halperintorahtots.com/makepayment (credit card, ACH, Debit Card)

How did you hear about Tot Shabbat?*

PARENT/CHILD INFORMATION

REGISTRATION