« Back to Chabad Center of Northwest New Jersey

Juda Kids Club Rockaway

ב"ה

JUDA - RSVP

JUDA Kids Club - Registration Form
Event: KIDS’ RESIN Mezuzah WORKSHOP

Date & Time: Sunday, January 26 | 4:00PM

Location: 1 Torah Way, Rockaway NJ

A special bonus!
We’re thrilled to partner with CKids to gift you a free Mezuzah alongside your child’s handmade case! To be eligible, sign up now at OneMitzvah.org/CKids-Mezuzah-Campaign/JudaRockaway. After the workshop, we’ll help you place it on your door!

Dinner Available!
We’ll be serving a light pasta dinner with fresh hot pasta and cut vegetables for just $5 per person.
Child's Name (#1)*
First Name Last Name
Hebrew Name
Birth Date*

Month Day Year
School
Child's Name (#2)
First Name Last Name
Hebrew Name
Birth Date

Month Day Year
School
Child's Name (#3)
First Name Last Name
Hebrew Name
Birth Date

Month Day Year
School

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Parent/Guardian Information
Mother's Name*
First Name Last Name
Mother's E-mail*
Mother's Phone Number*
Fathers's Name
First Name Last Name
Fathers's E-mail
Father's Phone Number
Number of Children Attending:*

1 Child2 Children3 Children
Dinner: How many dinners would you like to order? $5 per person*

1 person2 People3 People4 People
Total

$0.00
Yes, I'd like to donate the cost of processing this transaction by adding 3%

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Should be Empty:

This page uses TLS encryption to keep your data secure.