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Department

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Date of Birth*

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Parents Address*

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Are you Jewish?* Check all that apply

Parents Info:

Father’s Name*

First Name Last Name

Father’s E-mail*

Father’s Phone*

Area Code Phone Number

Mother’s Name*

First Name Last Name

Mother’s Phone *

Area Code Phone Number

Mother’s E-mail*

I would like to attend

Friday Night Services & Dinner – 6:30 PMSaturday Morning Services & Lunch – 10:00 AM

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Donation Info (Optional)

Shabbat Meals and Services is being offered free of charge. Donations are encouraged and greatly appreciated to help cover the costs.

Please consider making a donation now to help us continue our vital work!

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Please mail your check to: Lubavitch Chabad Jewish Center, 2021 NW 5th Ave. Gainesville, FL 32603