HS Shabbaton

First Name *

Last Name *

Phone *

Email *

Grade *

Parent Cell *

Student Cell *

Where would you like your son to return on Saturday night? *

Home Address *

By checking the box I agree that my child, whose name is stated above in box one, has permission to attend the JEC High School Shabbaton, October 20-21 2023. I understand that my son is to follow all rules as set forth by the trip chaperones. *

I agree

I do not agree

If needed - a JEC staff member may give my son medication *

I agree

I do not agree

Please type your name in the box to confirm your consent and identity. *

Comment

Coupon

Total Amount

$

Discount Amount

$

Gross Amount

$

Payment method *

Paypal
Credit Card

Billing Zipcode*

Credit Card Number*

Expiration Date*

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Card (CVV) Code*

Card Type*

Card Holder Name*

Verification code*