Yom Kippur Children's Services Parent/Guardian Name(Required) First Last Address(Required) Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone(Required)Email(Required) Location - Monday September 25th(Required)Please select which location, you will be attending. Chabad of Deerfield - 945 Sunset Ct. - Deerfield @ 11:30 am Central Avenue Synagogue - 874 Central Avenue, Highland Park @ 11:30 am Child InformationNumber of Children(Required)01234Child Name(Required) First Last Hebrew Name(Required) Date of Birth(Required) MM slash DD slash YYYY Child #2 InformationChild Name(Required) First Last Hebrew Name(Required) Date of Birth(Required) MM slash DD slash YYYY Child #3 InformationChild Name(Required) First Last Hebrew Name(Required) Date of Birth(Required) MM slash DD slash YYYY Child #4 InformationChild Name(Required) First Last Hebrew Name(Required) Date of Birth(Required) MM slash DD slash YYYY Donation AmountDonation not required, but appreciated!$0.00$18.00$36.00$54.00$72.00$180.00Donation Total We appreciate your generosity towards the future of the Dr. Sue Library!Credit CardCard Details Cardholder Name Questions? Contact michla@nschabad.org
