Registration

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Child’s First Name *

Child’s Last Name *

Nickname (optional)

Child’s Age *

Child’s School *

Child’s Grade *

Dates Preferred (choose all that apply) *

Parent’s First Name: *

Parent’s Last Name: *

Address: Number and Street Name *

City *

State *

Zip *

Do you want art supplies to be shipped here? *

Enter Address for Shipping Art Supplies (if applicable)

Parent’s Phone (Cell) *

Parent’s Phone (Home)

May we text you regarding Yeshiva Break Museum Camp? *

Parent’s Email Address *

Questions?