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ב"ה

Summer Trip

I Give permission for my child to attend Summer trip, August 3.

Drop off is at Chabad on 17th, Wednesday Aug. 3, 10:30am.

Pick up at Chabad on 17th, 6:00pm.

Transportation and lunch provided.
Parents name

First Name Last Name
Students name

First Name Last Name
Trip cost

$35
Total

$0.00

Payment

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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