KADIMA APPLICATION FORM
2006-2007
 

Name ______________________________________  Nickname ____________________


Address __________________________________________________________________

        __________________________________________________________________


Child's Cell Phone  (_____) _____-________   Home Phone  (_____) _____-________  


E-mail________________________________________   Birthdate _________________


Grade _________  School ___________________________________________________ 


Comments/Questions? _______________________________________________________


__________________________________________________________________________


============================ Parental Information =========================

Mother ____________________________   Father _____________________________


Mom's Hebrew Name _________________  Dad's Hebrew Name ___________________

Cell # (_____)______-___________       Cell # (_____) _______-___________  


Parent's E-mail (checked most often) ________________________________________

Synagogue Affiliation _____________________________________________________

Parent/Guardian Signature ________________________________  Date __________
Dues:
B'nai Tikvah Member$35.00
Non-Temple Affiliated Member   $50.00
    Amount Enclosed: $ _____________

        Kadima, c/o
        Congregation B'nai Tikvah
        1001 Finnegans Lane
        North Brunswick, NJ 08902