Childcare for the Israeli Wine Tasting Event

Childcare for the Israeli Wine Tasting Event
Please provide us with the following information for childcare during the Israeli Wine Tasting Event. Children must be picked up by 7:00 p.m. (Don't forget to sign up for the event and fill out and bring this release form for your child.)
Name of Child

First NameLast Name
Age of Child
Minimum age: 3 years old
Name of Child

First NameLast Name
Age of Child
Minimum age: 3 years old
Name of Child

First NameLast Name
Age of Child
Minimum age: 3 years old
Parent Name

First NameLast Name
Phone Number

Area CodePhone Number
E-mail
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Should be Empty: