Mini Minyan Shabbos Program RegistrationThe program will run from 10:30am -12:15 pm for boys & girls in Nursery (can only come to the program if 3 years old and fully toilet trained) to grade 7.Boys Grades 5-7 New program in Shul near their Father. Children can only be at the program with a Parent in shul. Father's Name*First NameLast NameE-mailPhone NumberArea CodePhone NumberMother's Name*First NameLast NameE-mailPhone NumberArea CodePhone NumberNumber of children attending Shabbos ProgramChild 1First NameLast NameGenderMaleFemaleGradeNursery/ 3 years old- completely toilet trainedJKP1AGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Child 2First NameLast NameGenderMaleFemaleGradeNursery/ 3 years old- completely toilet trainedJKP1AGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Child 3First NameLast NameGenderMaleFemaleGradeNursery/ 3 years old- completely toilet trainedJKP1AGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Child 4First NameLast NameGenderMaleFemaleGradeNursery/ 3 years old- completely toilet trainedJKP1AGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Child 5First NameLast NameGenderMaleFemaleGradeNursery/ 3 years old- completely toilet trainedJKP1AGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Child 6First NameLast NameGenderMaleFemaleGradeNursery/ 3 years old- completely toilet trainedJKP1AGrade 1Grade 2Grade 3Grade 4Grade 5Grade 6Grade 7Do any of your children have allergies? if yes, which child, what are they allegic to, what to do if they come in contact?Which Minyan do you davenMain ShulShteebleCheck box*I give my child/children permission to leave the Shabbos Program at 12:15 on their own.My child/children will be picked up from the Shabbos program at 12:15 by a family member.Please choose one of the following options for monthly charges (10 months)*$25 CAD$36 CAD$54 CADIf you would like to pay by cheque, you may do so for the next 9 months. Please email us to remove you from reoccurring billing.A credit card for the first payment is needed in order to register. Payment*Credit CardVisaMasterCardAmerican ExpressCredit Card TypeCredit Card NumberName on Card1 - January2 - February3 - March4 - April5 - May6 - June7 - July8 - August9 - September10 - October11 - November12 - DecemberExpiration Month2022202320242025202620272028202920302031Expiration YearBilling AddressStreet AddressStreet Address Line 2CityState / ProvincePostal / Zip CodePlease SelectUnited StatesAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChilePeople's Republic of ChinaRepublic of ChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCook IslandsCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonThe GambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern MarianaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPitcairn IslandsPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint BarthelemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSomalilandSouth AfricaSouth OssetiaSpainSri LankaSudanSurinameSvalbardSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTristan da CunhaTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamBritish Virgin IslandsUS Virgin IslandsWallis and FutunaWestern SaharaYemenZambiaZimbabweOtherCountrySubmitShould be Empty: This page uses TLS encryption to keep your data secure.