Chanukah Paint Night-Dec.12th

*Please fill in one (1) form per household

* First Name

* Last Name

* Phone Number

PLEASE NOTE: DORSHEI EMET MEMBERS HAVE PRIORITY

* TOTAL number of people attending from your household:

Please list the names of the ALL individuals who will attend:

If you selected "Other" where did you hear about the program?

* I acknowledge the photo disclaimer below:

I acknowledge the photo disclaimer below:Photos of you may be taken during this event.Congregation Dorshei Emet may use these photos in synagogue publications, flyers and on the screens in the lobby. Please contact Cynthia Weinstein at executivedirector@dorshei-emet.org with questions.