HUMMER PARADE REGISTRATION

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Grand Chanukah Hummer Parade
Hummer Parade Schedule:
4:30 pm - Come get a Menorah for your car
5:00 pm - Reception and Menorah lighting
6:00 pm - Parade
7:00 pm - Pick up after the Parade

Please consider contributing $18 per child
Parent Full Name*
First Name Last Name
Parent E-mail*
Parent Phone Number*
Child Name*
First Name Last Name
Child Birth Date*

Month Day Year
I like my child to ride in*
Emergency Contact Information
Full Name of Primary Contact Person*
Phone Number of Primary Contact Person*
Permission Waiver
I hereby grant permission for my child to participate in the Shaloh House Chanukah Parade. I understand that my child must arrive at Shaloh House no later than 5:00 pm on Thursday, December 26th, and must be picked up at 7:00 pm.
Please agree to the above by typing your full name below:
Join the Parade! Please check below how you would like to be involved in the parade

Yes! I would like to join the parade with my own vehicle and will come early (4:30pm) to have a Menorah mounted on my car.Yes! I would like to join the parade with my own vehicle but am not interested in having a Menorah mounted on my car.No thank you, only my child will be attending the parade (please join us at the reception at 5:00 pm)
Special Requests If you would specifically like your children to be together, please specify in the comment box below and we will try our best to accommodate
Payment (optional)
$18 per child

$18$36$54
Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

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Grand Chanukah Hummer Parade