How many adults will be attending?

How many children will be attending with you?

Do you currently receive PJ Library Books?

Multiple Households?

Adults/Guardians are in separate Households

Children's Household

Parent/Guardian 1Parent/Guardian 2

Dinners Options

Please BYO Picnic-Style Dinner, or order a Kosher boxed dinner for some Shabbat yummies! Challah and grape juice will be provided.

Tuna Wrap (includes fruit and dessert): $14.50
Hummus Wrap (includes fruit and dessert): $14.50
Sunbutter and Jelly Wrap (includes fruit and dessert): $6.00

Adult/Guardian 1

First Name

Last Name

Cell Phone

Street Address

City

State

Postal Code

Date of Birth

Meal Selection

Adult/Guardian 2

First Name

Last Name

Cell Phone

Street Address

City

State

Postal Code

Date of Birth

Meal Selection

Child 1

First Name

Last Name

Cell Phone

Date of Birth

Grade

Meal Selection

Child 2

First Name

Last Name

Cell Phone

Date of Birth

Grade

Meal Selection

Child 3

First Name

Last Name

Cell Phone

Date of Birth

Grade

Meal Selection

Child 4

First Name

Last Name

Cell Phone

Date of Birth

Grade

Meal Selection

Child 5

First Name

Last Name

Cell Phone

Date of Birth

Grade

Meal Selection

Additional Information

Do you need any accommodations to make this experience meaningful?

Do you or your children have any allergies or health concerns? If so, please list.

I give permission for any photographs taken of my child(ren) be used for promotional purposes:

Payment Information

Amount Due

.00

Name on Card

Card Number

MM (2 Digit)

YY (2 Digit)

Code

Billing Email

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