בס"ד Kids in the Kosher Kitchen REGISTRATION Family Name: Mother's Name: Father's Name: Child's Name: Date of Birth: -- Month -- Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec -- Day -- 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 -- Year -- 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 E-mail: Sessions attending: Full Progran September 24 December 12 January 21 February 26 May 13 Total Amount: $10 two sessions $ 45 Year Membership Payment Method: -- Select-- Visa Master Card AMEX Check Name on Credit Card: Credit Card Number: Code: Expiry Date: -- Month -- Jan Feb Mar Apr May June July Aug Sept Oct Nov Dec -- Year -- 2017 2018 2019 2020 2021 Please list any food allergies: This page uses 128 bit SSL encryption to keep your data secure.