Your Student's Info

Name*

First Name Last Name

Phone*

Area Code Phone Number

E-mail*

Home Address*

Birthdate*

Month Day Year

Graduation Year:

Fraternity / Sorority: (if applicable)

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 am attending* Check all that apply

Number of family members attending: * (including your student/s)

Comments or questions:

Family Weekend meals and programs are being offered free of charge. Donations are encouraged and greatly appreciated.

Donation Amount (Optional)

Payment (Optional)

Credit Card Paypal Check/Venmo/CashApp/Zelle

Postal / Zip Code

Country

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