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Virtual Summer High School Program
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Personal Details
First Name
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Your answer
Last Name
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Your answer
Cellphone
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Your answer
Home Phone
Your answer
Home Address - House number, Street, City, State, Zip code
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Your answer
Email
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Your answer
High School
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Your answer
Grade you will enter in September 2020
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11
12
Other:
Parent Info
Parent Name
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Your answer
Parent Cellphone
Your answer
Parent Email
*
Your answer
I give permission for Midreshet Lindenbaum to use photos of my daughter in a newsletter/Facebook page, etc.
Yes
Please submit a payment of $180 at
https://www.lindenbaum.org.il/payments/Default.asp
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