CteenJr Trip - JewishSMonica.com

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Winter Break Day Trip to Ice Skating!! 6th-8th grade girls!
Parents name*
First Name Last Name
E-mail*
Students name*
First Name Last Name
Is this your first time attending an event from Chabad in S. Monica (Bat Mitvah Club, Cteen Jr etc)

YesNo
Is the mother of the student attending Jewish

YesNo
Are there any conversions to Judaism in the family? If yes, please explain who and what Rabbi did the conversion.
Trip cost*

$85
Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
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Name on Card
Expiration Month	Expiration Year

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