Name Parent 1*

Email Parent 1*

Phone Parent 1*

Address Parent 1*

City or Town Parent 1*

If not applicable, write NA

Name Parent 2

Email Parent 2

Phone Parent 2

Address Parent 2

City or Town Parent 2

Children: Names and Date of Birth*

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

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

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