Summer Camp Registration - Menachem Mendel Academy

Parent/Guardian's Name *

First

Last

Second Parent/Guardian's Name

First

Last

Email *

Phone Number

Preferred Contact Method *

How many children are you enrolling? *

Child's Name *

First

Last

Child's Date of Birth//

Program

Second Child's Name

First

Last

Second Child's Date of Birth //

Second Child's Program

Third Child's Name

First

Last

Third Child's Date of Birth//

Third Child's Program

Fourth Child's Name

First

Last

Fourth Child's Date of Birth//

Fourth Child's Program

Comment or Message

Anything we should know about you or your child(ren)