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Kids Cocoa Club

Register Below for $49/year per child. (school year).

Join us every Sunday mornings at Or Shalom (96 Fredmir Street, DDO) from 9:30am to 10:00am.

One form per child, please.
Child's Full Name*

First Name Last Name
Child's Hebrew Name*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Child's Birthday*

Month Day Year
at Hour Minutes
Please indicate if your child has any allergies or intolerances:*
Mothers Full Name*

First Name Last Name
Fathers Full Name*

First Name Last Name
Mothers Phone Number*

Area Code Phone Number
Fathers Phone Number*

Area Code Phone Number
Paying $49 for one child for 2022-2023 (school year)*
Total

$0.00

Payment

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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