THIS FORM IS NO LONGER ACTIVEPLEASE CONTACT HADASSAH 516-458-3694 FOR ALL INFORMATIONNumber of Teens Resgistering*12Teen #1 InformationFull NameFirst NameLast NameGradeSchoolTeen Cell NumberArea CodePhone NumberTeen #2 InformationFull NameFirst NameLast NameGradeSchoolCell NumberArea CodePhone NumberParent InformationMothers NameFirst NameLast NameMother Cell NumberArea CodePhone NumberFathers NameFirst NameLast NameFather Cell NumberArea CodePhone NumberE-mail to receive confirmation*To make alternate payment plans please contact Hadassah: 516-458-3694Number of Teens Registering$55 Per StudentTotal$0.00SubmitShould be Empty: This page uses TLS encryption to keep your data secure.