Name of Person Completing the Form*

Email*

Cell*

Address*

City/Town*

State*

Zip Code*

Name of Spouse/Partner (if applicable)

Do you currently receive PJ Library books?*
YesNo

Children: Names and ages of your child(ren)*

Do you want to be matched with a buddy family?
YesNo

If you have a buddy family who is not Jewish and who would like to participate as your buddy family, please provide a parent's name and email so a registration link can be sent to them:

Name of temple you belong to if you have a temple membership. Temple membership is not required to participate in the program.

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