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Candle Lighting for Fri. May 25, 2012 in
East Brunswick
is:
6:56pm
Shabbat ends at:
8:00pm
Saturday, 19 May 2012. Yom Shabbat, 27 Iyyar 5772
Chabad of East Brunswick
Holiday Programs
Hebrew School
Youth Programs
Women's Programs
Community Services
Adult Education
Friendship Club
High Holiday Services
Shabbat Services
Good Deed Awards
Chai Preschool
Online Torah Study
Living Torah Studio
The Rebbe
About Kabbalah
Regional Center
Kids Zone
Kosher Establishments
Child Friendship Club Registration
Personal Information
Child's name:
Gender:
male
female
Age:
Grade:
Birth date:
Address:
City:
ZIP code:
State:
Home phone:
Email:
School name:
School telephone number:
Father's name:
Cell phone:
Work phone:
Email:
Mother's name:
Cell phone:
Work phone:
Email:
Friends At Home
When would you like to have the volunteers visit your child?
1st Choice:
Day of the week:
Time:
2nd Choice:
Day of the week:
Time:
Would you be willing to drive the volunteers TO or FROM your home?
no
to
from
Do you have a preference for a specific volunteer?
yes
no
Name (if yes):
Parental Consent:
We are happy to accommodate you with our Friends at Home program. However, it is necessary for parents/ guardians to assume responsibility to oversee activities shared together. I agree that a parent/guardian will be at my home while the volunteers are interacting with my child. By signing below, I release the Friendship Club, its providers and administrators from ALL liability for any incident which affects the health, welfare or safety of my child in the provision of such service.
I permit my child's photo to be used for publicity purposes:
yes
no
Your initials as signature
