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Early Childhood - Mazal Tots Winter Form

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Items with a * are required.

Primary #1

* First Name

* Last Name

Address

City

State

Zip

* Home Phone #

* Mobile Phone #

* Email Address

Business Phone #

Primary #2

* First Name

* Last Name

Address

City

State

Zip

Home Phone #

Mobile Phone #

* Email Address

Business Phone #

Number of Children

Child #1 Information

* First Name

Gender

* Date of Birth

Child's Hebrew Name

* Please select the days you will attend

Sunday, January 23Sunday, February 6Sunday, March 6Sunday, March 20

Child # 2 Information

* First Name

Gender

* Date of Birth

Child's Hebrew Name

* Please select the days you will attend

Sunday, January 23Sunday, February 6Sunday, March 6Sunday, March 20

Child # 3 Information

* First Name

Gender

* Date of Birth

Child's Hebrew Name

* Please select the days you will attend

Sunday, January 23Sunday, February 6Sunday, March 6Sunday, March 20

Child # 4 Information

* First Name

Gender

* Date of Birth

Child's Hebrew Name

* Please select the days you will attend

Sunday, January 23Sunday, February 6Sunday, March 6Sunday, March 20

* Are you a member of CBO?

Please Select OneYesNo

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Please note that in the case of inclement weather the class will be canceled.

Wed, May 18 2022 17 Iyyar 5782

2550 South Centre Avenue

Bellmore, NY 11710

(516) 781-3072

Affiliated with United Synagogue of Conservative Judaism