10Holidays And Parties_fireworksLeft_b_FFFFFF_000000.jpg

10Holidays And Parties_fireworksRight_b_FFFFFF_000000.jpg

Youth Registration Form High Holidays 5773

Congregation Beth Shalom

5915 Beacon Street

Pittsburgh, PA 15217

412.421.2288

www.bethshalompgh.org

Child's Information

Child #1

First Name

Last Name

Sex

Birth Date

Grade

Child #2

First Name

Last Name

Sex

Birth Date

Grade

Child #3

First Name

Last Name

Sex

Birth Date

Grade

Child #4

First Name

Last Name

Sex

Birth Date

Grade

Family Contact

Parent #1

First Name *

Last Name *

Parent #2

First Name

Last Name

Contact Info

Address 1

Address 2

City

State

Zip

Parent #1 Phone

Parent #2 Phone

Email Address

Email Address

Grandparent(s) Name?

What Camp Will Your Child Be Attending This Summer?

What School Does Your Child Attend?

Powered by Formsite

Formsite