Makor Registration 2020-21

Use this form to register your child or children for Makor. You can also use this form to pay your fees by credit card. There is an additional fee for all credit card transactions.

Parent's Name
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email
Would you like to add another parent or emergency contact?
- Yes
- No
Second Parent or Emergency Contact's Name
First Last
Second Parent or Emergency Contact's Phone
Second Parent's Email
Will you be paying by credit card?
- Yes
- No
Child's Name
First Last
Child's Grade (k)
Child's Grade (c)
Describe any allergies or special needs this child has:*
Would you like to register another child?
- Yes
- No
Second Child's Name
First Last
Second Child's Grade (k)
Second Child's Grade (c)
Describe any allergies or special needs this child has:
Would you like to register another child? (3)
- Yes
- No
Third Child's Name
First Last
Third Child's Grade (k)
Third Child's Grade (c)
Describe any allergies or special needs this child has:
It is okay for Temple Beth Or to photograph my child/children.*
Unless you specifically tell us not to, we may take photos of your child to promote our programs in print and online. If you have questions about how we use photos, please call the office at 937-435-3400.
Total
$0.00
Credit Card

American Express
Discover
MasterCard
Visa
Card Number Expiration Date Security Code Cardholder Name

Makor Registration 2020-21

Makor Registration 2020-21

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