Name Parent 1*

Email Parent 1*

Phone Parent 1*

Address Parent 1*

City or Town Parent 1*

If not applicable, leave blank

Name Parent 2

Email Parent 2

Phone Parent 2

Address Parent 2

City or Town Parent 2

Is at least one parent Jewish?
YesNo

If you live outside of Lappin Foundation's service area, list the name of the JCC or Temple in our service area of which you are a member.

Children: Names and Date of Birth*

Are your children already enrolled in PJ Library?
YesNo

Is your family doing Rekindle Shabbat with a buddy family? A buddy family should meet the eligibility requirements for Rekindle Shabbat.
YesNo

If you are doing Rekindle Shabbat with a buddy family, what is your buddy family's name?

Buddy Family Phone

Buddy Family Email Address

Are you interested in the food option?
YesNoMaybe

How did you hear about Rekindle Shabbat?
Friend/RelativeTempleSchoolSocial MediaInternet SearchMacaroni KidNewspaperOther

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