ITJ Registration Form
We are pleased that you are registering for Haver's ITJ class. Please fill out this registration form completely. If you are registering with a partner or spouse, please list the primary contact person (or the one considering conversion) as Adult 1 and the partner or spouse as Adult 2.

Please provide cell phones so that we can contact you with critical information. We will contact you via text for any last minute location changes or if we have to cancel class.

Questions? Contact Stacey at
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Email *
Adult 1 - Name *
Adult 1 - Address Line 1 *
Adult 1 - Address Line 2 (if needed)
Adult 1 - City, State, Zip *
Adult 1 -  Phone Number *
Adult 1 - I prefer to be referred to with these pronouns:
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Adult 2 - Name
Adult 2 - Email Address
Adult 2 - Phone Number
Adult 2 - Address Line 1  (if different from Adult 1)
Adult 2 - Address Line 2 (if needed/different)
Adult 2 - City, State, Zip (if different)
Adult 2 - I prefer to be referred to with these pronouns:
Clear selection
Do you have a sponsoring rabbi? *
If yes, who is your sponsoring rabbi?
If you do not have a sponsoring rabbi, can we help you identify a rabbi to work with you? We highly encourage you to establish a relationship with a rabbi. If you mark "yes," we will contact you.
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Do you have any allergies that can be a danger to you in this class (e.g., peanuts, milk, etc.)? Please explain. This information is helpful when we meet in person.
We aim to include individuals of any age who may temporarily or permanently move, hear, see, touch, think, learn, communicate, process stimuli, or experience emotions differently. Would you like to tell us of an accommodation that would be helpful to you?
I am paying (check all that apply)... *
I am participating in this class because (check all that apply)... *
I heard from about this ITJ class from: *
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