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Kadima - Adrenaline Monkey

Sunday, January 12, 2020
12:00 am - 3:00 pm
Drop-off and pick-up at Park Synagogue East

Be sure you're already registered for Jr. Kadima/Kadima membership for the new year!

* Child's name

* Event fee

* Please initial to indicate that your child has permission to attend this event

https://adrenalinemonkey.centeredgeonline.com/waivers

Did you fill out the waiver above?

	Yes
	No

* Parent cell phone during time of event

* I am able to chaperone

*E-mail

*First Name

*Last Name

Account

Name on Card

Card Type

Card Number

Expiration Date

Card Verification Number

Address Line 1

City

State/Province

Zip

Comments

Increase the amount by 3% to cover credit card fees. Please select YES to increase your payment.

Total: