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Youth Group Registration
Please verify reCaptcha before submitting the form.
First Name
Last Name
Email Address
Phone Number
Are you a member of Merrick Jewish Centre?
Yes
No
Number of Member Children Being Registered @ $80 Each
0
1
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9
10
Number of Non-Member Children Being Registered @ $95 Each
0
1
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9
10
Names and Grade of Each Child Being Registered
Total Amount Due
Tue, October 21 2025 29 Tishrei 5786
