THIS FORM IS NO LONGER ACTIVE PLEASE CONTACT HADASSAH 516-458-3694 FOR ALL INFORMATION Number of Teens Resgistering* 1 2 Teen #1 Information Full Name First Name Last Name Grade School Teen Cell Number Area Code Phone Number Teen #2 Information Full Name First Name Last Name Grade School Cell Number Area Code Phone Number Parent Information Mothers Name First Name Last Name Mother Cell Number Area Code Phone Number Fathers Name First Name Last Name Father Cell Number Area Code Phone Number E-mail to receive confirmation* To make alternate payment plans please contact Hadassah: 516-458-3694 Number of Teens Registering $55 Per Student Total $0.00 Submit Should be Empty: This page uses TLS encryption to keep your data secure.
This page uses TLS encryption to keep your data secure.
This page uses TLS encryption to keep your data secure.
This page uses TLS encryption to keep your data secure.
