To Chabad of Squirrel Hill:
Please enroll my child in the Jewish Discovery Hour  Program  
Child's First Name
Last Name
Address  
City/State/Zip         
Phone Number
Cell Number
Email address  
Grade  
Comment (optional)  

As the Parent or legal guardian of the above child, I enroll my above child in the Jewish Discovery Hour Program, and give permission to Chabad of Pittsburgh to pick my child up from Colfax Elementary School on Thursdays at 2:00pm to participate in the program.

Name      Initials      Date