Eitanim Registration & Payment 2023-2024

Parent Information

First name*

Last name*

Email*

Phone number*

Home Address

Street address*

Street address 2

City*

State

Postal code*

First Name*

Last Name*

Email*

Phone Number*

Date of Birth*

Month/Day/Year

Gender*

Identity*

Grade Entering*

Name of School

T-shirt Size*

Allergies?*

List of Allergies

Add 2nd participant?

Add 3rd participant?

By checking the box, I'm providing my electronic signature, which is the same as a handwritten signature.

I acknowledge and agree to follow the rules, policies, and guidelines set forth by IAC Eitanim.*

By checking the box, I'm providing my electronic signature, which is the same as a handwritten signature.

I agree to all the IAC policies and terms and conditions*