Payment Form - Inclusion Workshop - The Friendship Circle of Dallas

Please compete the form below to sign-up! You may contact Leah with any questions: [email protected]
*Some participants are completing this program as part of their b'nei mitzvah project. Participation is open to any Jewish boy or girl in 5th, 6th, or 7th grade, regardless of their b'nei mitzvah date or other projects. Participants are required to make a donation, complete both sessions, and attend the carnival.
Child's Full Name*
First Name Last Name
Grade Level*

5th6th7th
Parent Full Name*
First Name Last Name
Parent Phone Number*
Parent E-mail*
Donation*

$36$54

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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