בס"ד Kids in the Kosher Kitchen REGISTRATION This page uses 128 bit SSL encryption to keep your data secure. Family Name: Mother's Name: Father's Name: Child's Name: Date of Birth: -- Month -- Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec -- Day -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 -- Year -- 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 E-mail: Sessions attending: Full Progran Nov. 22nd Jan. 10th Feb. 14th March 20th April 10th May 15th June 5th Total Amount: $30 Full program $5 single session $10 two sessions $15 three sessions $20 four sessions $25 five sessions Payment Method: -- Select-- Visa Master Card Cash / Cheque Name on Credit Card: Credit Card Number: Code: Expiry Date: -- Month -- Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec -- Year -- 2013 2014 2015 2016 2017 2018 2019 2020 Please list any food allergies: This page uses 128 bit SSL encryption to keep your data secure.
