HH Babysitting Form

"*" indicates required fields

To maintain appropriate staff / child ratios, please complete this form and return with payment in full to the Temple.

Juice and cookies will be provided.

If needed, please bring disposable diapers and any other special items for your child.

Are you a synagogue member?*

Yes

Members: Number of Children - Rosh Hashana Day 1

Price: $15.00

Non-Members: Number of Children - Rosh Hashana Day 1

Price: $25.00

Members: Number of Children - Rosh Hashana Day 2

Price: $15.00

Non-Members: Number of Children - Rosh Hashana Day 2

Price: $25.00

Members: Number of Children - Yom Kippur (morning service only)

Price: $15.00

Non-Members: Number of Children - Yom Kippur (morning service only)

Price: $25.00

Children*

Name

Age

Allergic to:

Payment Information

Payment Method*

Pay by credit card

Pay by check

Please make your check payable to the synagogue and mail it to the synagogue office with a copy of the email receipt you will receive upon submission.

Please note that upon submission, you will be taken to PayPal's website in order to enter your credit card information.

Would you like to add an amount to cover the credit card convenience fee?

Yes - let me add a 2.2% + .30 contribution

Additional contribution to cover the credit card convenience fee

Price: $0.00

Total

Billing Information

Billing Name*

First Last

Billing Address*

Street Address City State ZIP Code

Billing Phone*

Billing Email*

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HH Babysitting Form

Payment Information

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