Youth Shabbos Graduation

Youth Shabbos/Graduation - June 9, 2018

Ner Tamid is excited to congratulate all of our graduates. Please give us the information of the graduates. Sponsorship appreciated.
Full Name of Parent *

First Name Last Name
E-mail *

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Best Contact Phone *

- Area Code Phone Number
Emergency Number

- Area Code Phone Number
Student Information
Student #1 Name

First Name Last Name
School
Level Graduating
Student Degree (if applicable)
Student #2 Name

First Name Last Name
School
Level Graduating
Student Degree (if applicable)

Sponsorship (optional)

Youth Shabbos $ 36.00

Quantity

Total $ 0.00

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

Notes/Comments
LIABILITY RELEASE: I/we agree to indemnify and hold harmless Ner Tamid Greenspring Valley Synagogue, it’s officers, directors, coaches, representatives, school or park facilities for any injury or loss of property suffered from my child('s) arising out of or in connection with participation in the Ner Tamid Youth activity.
LIABILITY RELEASE *

Agree
Should be Empty: