Teen Scene - Form - Congregation Beth Shalom

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Teen Scene

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2018 -2019 TEEN SCENE

Please fill out this form and submit payment to enroll in Teen Scene for the 2018 - 2019 school year.

First Name

Last Name

Email

First Name (2nd student) Optional

Last Name (2nd student) Optional

Email (2nd student) Optional

Mother's name

Father's Name

Mother's Email

Father's Email

Mother's Phone Number

Father's Phone Number

Select the number of students enrolling - Beth Shalom member cost is $136 per student

Select the number of students enrolling - Non Member cost is $156 per student

Tue, April 23 2024 15 Nisan 5784

CONGREGATION BETH SHALOM

5303 winters chapel road

DUNWOODY, GA 30360

770-399-5300 - EMAIL OFFICE@BETHSHALOM.NET

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