Passover Chaplain Donation Form

Chaplains Passover Donations Items
ORDER DEADLINE: FEB 18, 2026

Please note that you can save this form by clicking the save button on the bottom of the page. If you need to stop filling out the form and return to complete it at a later date, just click the "Save" button.
Work Email*
example@example.com
Please check off which meal(s) this order is for:*

1 Seder Meal Only2 Seder MealsEntire Passover Holiday

Contact Information
Contact Name*

PrefixFirst NameLast Name
Institution Name
Phone Number*
Please enter a valid phone number.
Select Your Institution. First select your state then the Institution name*
Shipping Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

IF YOU ARE REQUESTING A DONATION, YOU ORDER MUST BE ACCOMPANIED BY AN UPDATED LIST OF THE JEWISH INMATES AT YOUR INSTITUTION.

PLEASE ENTER THEM BELOW.

IF THIS CANNOT BE PROVIDED, PLEASE CALL RABBI KATZ AT 305-864-5553
Number of Jewish People*
I am unable to provide the list of Jewish people at my facility

I will call Rabbi Katz at 305-864-5553
List of Jewish People
Primary Affiliation
Should be Empty: