Youth Group Registration - Form - Merrick Jewish Centre

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Youth Group Registration

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First Name

Last Name

Email Address

Phone Number

Are you a member of Merrick Jewish Centre?

YesNo

Number of Member Children Being Registered @ $80 Each

Number of Non-Member Children Being Registered @ $95 Each

Names and Grade of Each Child Being Registered

Total Amount Due

Sun, April 2 2023 11 Nisan 5783

225 Fox Boulevard • Merrick, NY 11566 • 516-379-8650

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