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Masa Class Enrollment Form

STUDENT INFORMATION

PARENT 1 INFORMATION
PARENT 2 INFORMATION

Medical Information
**In addition to filling out information below, please submit a copy of your insurance card to Nancy Gorod, Director of Congregational Learning (ngorod@shearithisrael.com/404.503.9906).

ADDITIONAL INFORMATION

Enrollment Fees
**Trip to New York will have additional fees**

Wed, June 19 2019 16 Sivan 5779