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Limmud Centre Registration 2018-19
Email address *
Child's Full Name *
Your answer
Child's Age *
Your answer
Child Date of Birth *
MM
/
DD
/
YYYY
Mother's Full Name *
Your answer
Cell Number *
Your answer
Email Address *
Your answer
Father's Full Name *
Your answer
Cell # *
Your answer
Email Address *
Your answer
Home phone number *
Your answer
Home Address *
Your answer
Does your child have any Allergies? *
Your answer
Does your child have any medical concerns? *
Your answer
Does your child take any medication? *
Your answer
In order to complete your registration, a non-refundable deposit of $100 per child is required by June 14th, 2018. *
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