Shifra & Puah Application

1
Name
First Name
Last Name
2
AddressPlease enter you full address. If you live on the outskirts of Flatbush, please call Mushky Bryski at 718-909-9081 to make sure we're able to deliver.
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
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Armenia
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Australia
Austria
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The Bahamas
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Belize
Benin
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Brazil
Brunei
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Burundi
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Canada
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Chad
Chile
China
Christmas Island
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Colombia
Comoros
Congo
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Cote d'Ivoire
Croatia
Cuba
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Cyprus
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Democratic Republic of the Congo
Denmark
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Eritrea
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Ethiopia
Falkland Islands
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Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jersey
Jordan
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Kenya
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North Korea
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Kuwait
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Laos
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Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
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Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
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Slovakia
Slovenia
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Somalia
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South Ossetia
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Spain
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eSwatini
Sweden
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Syria
Taiwan
Tajikistan
Tanzania
Thailand
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Togo
Tokelau
Tonga
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Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
3
Cross Streets* This field is required.Between ---- and -----
4
Notes about address (Help us reach you by providing any additional info that could be useful such as: side door, left door, basement, bell not working please knock, etc.)
5
Email* This field is required.
example@example.com
6
Phone Number* This field is required.
Please enter a valid phone number.
7
Date of Baby's birth
Date
Year
Month
Day
8
Boy or girl
Boy
Girl
9
Multiples:Please specify!
10
Shabbos Meals:
Unfortunately catered Shabbos meals are temporarily on hold until further notice.
Thank you for understanding!
11
Referred by
12
There is a special Sefer Torah being written in Israel specifically for babies and children!
I will look out for the flyer in the breakfast package.
I'll be happy to receive a call with more information.
13
For nursing challenges that can be addressed over the phone, Chaya Stern is volunteering to offer lactation support calls. To schedule a time, please call Chaya at 347-885-2602.
14
Some other programs at Chabad of Flatbush are: Playgroup; Hebrew school; classes; women's events; Shabbos kids program; family holiday events and more...
Please add me to the Chabad of Flatbush community email list.
Please notify me of day time events such as women's classes and mommy and me.
Should be Empty: