Child's Details:
Child's Full Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent Phone Number
*
Parent E-mail
*
example@example.com
Child's Age
*
Child's Grade
*
Any ideas you have for future events:
Please give names of any two people whom you feel would like a Middle School Hanukkah Survival Kit:
Full Name
Email Address
1
2
Thank you for filling out this form! We will email to let you know when your kit will be delivered. If you have any questions, please email Alison Roemer, aroemer@jewishlouisville.org
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