Shalshelet Registration
EARLY BIRD ENDS SEPTEMBER 30TH. REGISTER AND PAY BEFORE 9/30 TO RECEIVE DISCOUNT!
Your Daughter's Name
*
First Name
Last Name
School
*
Grade 2026-27
*
4th grade
5th grade
6th grade
7th grade
Does your daughter have any allergies?
*
Yes
No
If yes, please detail here:
*
Attended Shalshelet before?
*
YES!
Her first time!
Sign up additional daughter?
*
No
Yes
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Second Daughter's Name
*
First Name
Last Name
School
*
Grade 2026-27
*
4th grade
5th grade
6th grade
7th grade
Does your daughter have any allergies?
*
Yes
No
If yes, please detail here:
*
Attended Shalshelet before?
*
YES!
Her first time!
Sign up a third daughter?
*
No
Yes
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Next
Third Daughter's Name
*
First Name
Last Name
School
*
Grade 2026-27
*
4th grade
5th grade
6th grade
7th grade
Does your daughter have any allergies?
*
Yes
No
If yes, please detail here:
*
Attended Shalshelet before?
*
YES!
Her first time!
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Next
Parent's Name
*
First Name
Last Name
Parent's Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Email
*
example@example.com
Shul Affiliation
*
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We need YOU to help us shine!
Sign up to be added to a Mom's volunteer Whatsapp group and help make Shalshelet happen behind the scenes!
*
Add me!
Not at this time
Add this number to the Whatsapp
*
Please enter a valid phone number.
Format: (000) 000-0000.
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Please confirm below
I understand this is a full 8 week program. Any missed program dates will not be refunded under any circumstances.
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Shalshelet hours are on Sundays from 10am-12pm.
I understand pickup must be prompt. After 12:15pm there will be no supervision in the building.
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I agree that the program organizers, staff, and building are not responsible for any injury, loss, or damage that may occur during the program
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Parent's Signature
Today's Date
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Total:
Full payment must be sent before submitting registration form.
If you would like to pay with cash, please call/text 786-423-9787 to arrange BEFORE submitting this form.
Payment type
*
Zelle: shalsheletny@gmail.com
Venmo: shalsheletNY
Cash/Check - call/text 786-423-9787 before submitting form.
Upload a screenshot of your venmo/zelle confirmation receipt
*
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