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CKids Club Registration

Parent Information
Name*

First Name Last Name
E-mail*
I would like to receive news and updates by email
Phone Number*

Address*

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

Membership Options
How many children are you registering?*

123
Child Information
Child 1
Name*

First Name Last Name
Date of Birth*

Day Month Year
Time if birth* In Judaism, a day begins at the evening prior. This is to determine your child's correct Hebrew birthday for the birthday club.

DayNight
Gender*
Membership Option*
Child 2
Name*

First Name Last Name
Date of Birth*

Day Month Year
Time if birth* In Judaism, a day begins at the evening prior. This is to determine your child's correct Hebrew birthday for the birthday club.

DayNight
Gender*
Membership Option*
Membership Option (With 5% Sibling Discount)*
Membership Option (With 10% Sibling Discount)*
Child 3
Name*

First Name Last Name
Date of Birth*

Day Month Year
Time if birth* In Judaism, a day begins at the evening prior. This is to determine your child's correct Hebrew birthday for the birthday club.

DayNight
Gender*
Membership Option*
Membership Option (With 5% Sibling Discount)*
Membership Option (With 10% Sibling Discount)*
Payment Information

Payment*

Credit Card

We accept Visa, MasterCard, American Express
Credit Card Number
Expiration Month	Expiration Year

Total

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