2nd Semester

2nd Semester

Lunch & Dinner Registration
Parent's Name*

First NameLast Name
Parent's Email*
example@example.com
Student's Name*

First NameLast Name
Grade*
Grade*
Does your son have any allergies?*
Lunch and Dinner Options - Choose One*

Lunch only – $625.25Dinner only – $292.60Lunch & Dinner – $917.85
Total
Payment Method*

via FACTSvia Credit Card (3% credit card processing fee applies)
Total Payment

USDTotal

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Questions about the lunch and dinner program?
Contact Shimmie Katz at skatz@heichalhatorah.org
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