Nosh & Drash Monday Night School Registration 2018-2019
A deposit of $100 per student is due upon completion of this form.

Total tuition due is $400/yr for members of a Conservative congregation, and $475/year for others.

Scholarship forms must be returned to Carma Gargaro at Adat Shalom Synagogue (cgargaro@adatshalom.org). An application form is located online at http://adatshalom.org/wp-content/uploads/2018/04/scholarship-18-19.pdf

Student 1 Information
Please enter all information for student 1
Student 1 Name (first and last) *
Your answer
Gender *
Grade in Sept. 2018 *
School *
Your answer
Birthdate *
MM
/
DD
/
YYYY
Student cell phone *
Your answer
Student Email Adress *
Your answer
Student 1 Dietary needs (check all that apply)
Next
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms