The Weekly Wrap Registration Form
Use this form to register your teen and to complete payment for the program
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Email *
What is the name of the adult who we should contact for any follow up questions about this registration? *
What is the best way to reach the adult? *
What is your teen's legal name? *
What is your teen's Hebrew name? (skip if unknown)
What name does your teen go by? (First and last name) *
When is your teen's birthday? *
MM
/
DD
/
YYYY
What city and state does your child currently live in? *
What school does your child attend?
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