Campaign ID

Time for Toddlers

Thank you for registering for Time for Toddlers with Evan Haller at Temple Israel. The class will take place from 9:00 a.m. - 10:00 a.m. for 8 weeks, starting Wednesday, March 15 and continuing through Wednesday, May 24. (Specific dates are March 15, 22, 29; April 26; May 3, 10, 17, 24.) The cost is $160 per family. You may join at any time!

Please enter the information in this form. When you submit the form, you will have the option of paying by credit card, or, if you are a Temple Israel member, having the fee added to your account.

Parent/Guardian Information

First Name

Last Name

Email Address

Phone

Street Address

City

State

ZIP Code

Children's Information

Please share the names and ages of the children who will be attending:

Name

Age

Additional Information

Who will attend classes with the child(ren)

I will attendAnother adult will attendBoth I and another adult will attend

Please provide the name of the adult who will be attending the class:

First Name

Last Name

How did you learn about this class?

Is there any other information you would like us to have?

Payment Information

Billing First Name

Billing Last Name

Billing Email

Total Amount

Payment Method

Credit CardCheck

Please send a check for the amount listed above made out to Temple Israel. Please send the check attention Heidi Smith Hyde.

Payment Information

Billing Street Address

Billing City

Billing State

Billing ZIP Code

Card Number

Code

Authnet_Hidden_Fields

Contact Information