8th Grade Purim Shuttle

Parent Name*

First Name Last Name

E-mail*

Number of Children sending Shaloch Manos*

Child 1 Name*

First Name Last Name

Child 1 Grade*

Choose a Class(es) you want to send to for child 1 $30 each

No. of individual kids you want to send $2 each

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Child 2 Name*

First Name Last Name

Child 2 Grade*

Choose a Class(es) you want to send to for child 2 $30 eacc

No. of individual kids you want to send $2 each

List the Individual kids sending to:

Child 3 Name*

First Name Last Name

Child 3 Grade*

Choose a Class(es) you want to send to for child 1 $30 each

No. of individual kids you want to send $2 each

List the Individual kids sending to:

Child 4 Name*

First Name Last Name

Child 4 Grade*

Choose a Class(es) you want to send to for child 1 $30 each

No. of individual kids you want to send $2 each

List the Individual kids sending to:

Total

$0.00

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