Shalom Service Corps Registration

Registration

FOR AGES 9-10
You and your child will be provided resources to begin and guide the conversation about philanthropy in your home.

Parent 1 Information
Parent 1 Name*
First Last
Parent 1 Email*
Parent 1 Phone*
Parent 1 Address*
Street Address Address Line 2 City State ZIP Code
Parent 2 Information
Parent 2 Name
First Last
Parent 2 Email
Parent 2 Phone
Parent 2 Address
Street Address Address Line 2 City State ZIP Code

*if different from Parent 1
Child Information
Child's Name*
First Last
Birth Date*
MM slash DD slash YYYY
Bar/Bat Mitzvah Date*
MM slash DD slash YYYY

if applicable
Temple*
Graduation Year*
Phone
Email
This field is for validation purposes and should be left unchanged.