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Youth Registration

Youth Registration

Please complete this form in its entirety for each child participating in YIWH Youth programs.

* First Name

* Last Name

* Gender

* Date of Birth

* Age

* School

* Current Grade

Allergies Youth Dept should be aware of?

* Parent 1: Name

* Parent 1: Email

* Parent 1: Cell Phone

* Parent 1: Primary Shabbos/Yom Tov Minyan

Parent 2: Name

Parent 2: Email

Parent 2: Cell Phone

* Parent 2: Primary Shabbos/Yom Tov Minyan

* Home Phone

* Emergency Contact

* Emergency Contact Phone

Parents interested in volunteering?

Fri, April 19 2024 11 Nisan 5784

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