YOU MAY USE THIS FORM TO RESERVE FOR MULTIPLE PARTICIPANTS

THIS EVENT IS FIRST COME, FIRST SERVE WHEN ACCOMPANIED BY PAYMENT.

Our ACTIVE KIDZ LONG ISLAND trip for grades 1-6 will take place on Chol Hamoed, Tuesday, October 13th.
The bus will depart from YIJE at 10:00am and return to YIJE for Pizza. Kids can be picked up at the Shul at 2pm.

PRICE: $50
RESERVATION DEADLINE: SEPTEMBER 28TH
THERE WILL BE A $5 LATE FEE AFTER THE DEADLINE (SPACE PERMITTING)

PARENT'S INFORMATION

CHILDREN'S INFORMATION

PLEASE LIST EACH PARTICIPANT INDIVIDUALLY
- CLICK THE PLUS ICON BELOW FOR EACH NAME YOU ARE ADDING. 

NOTE: It is important for us to have your child's contact information, where available, in order for us to reach them during the trip if necessary.