Shalom Baby Fall 2022

Parent Information

Parent #1 Name

Phone Number

Parent #2 Name (if applicable) or second accompanying adult

Country

Address

City, Province and Postal Code

Baby information

Baby Name

Date of Birth

Terms & Conditions

I understand a photo/video of me and/or my child may be taken and may be used in marketing materials or on a website.

Your contact information will be shared with partners of this program.

I have read and agree to the terms above.

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