Please Fill Out and Return

1840 University Boulevard West, Silver Spring, MD 20902 301.649.3800

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301.649.3112 (fax)

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www.htaa.org

YOUTH SERVICES AND BABYSITTING FOR BOTH DAYS OF ROSH HASHANAH AND YOM KIPPUR Please Fill Out and Return by July 15, 2016 MUST BE PRE REGISTERED **Charge: $25.00 per child or $50.00 maximum per family Please indicate the number of children in each category. _____ Babysitting Program (Ages: up to 3 years; Time: 10:15 am – 12:30 pm) _____ K'Tongregation (Ages 4-7 or Pre-K through 2nd grade; Time: 10:15 am – 12:30 pm) ____ Junior Congregation (grades 3, 4, 5 & 6; Time: 10:15 am – 12:30 pm) Parents’ Names: ____________________________________________ Seat Location: __________________ Address __________________________________________________________________________________ Phone Number ____________________________________________________________________________ Email ____________________________________________________________________________________ Name(s) of Child(ren)

Age(s)

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**NOTE: If you have paid for a seat for your child in the Main Sanctuary, your child(ren) may also attend the Youth service(s) at no extra charge.