Parent's Name* First Last Address* Street Address City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Email* Phone*Number of Children Attending*Name of Child 1*Birthdate of Child 1* MM slash DD slash YYYY School Child 1 Attends*Name of Child 2Birthdate of Child 2 MM slash DD slash YYYY School Child 2 AttendsName of Child 3Birthdate of Child 3 MM slash DD slash YYYY School Child 3 AttendsIs this the first time you have attended an event at Mirowitz?* Yes No How did you hear about Mirowitz STEAM Studio?* Postcard in the mail Postcard from pre-school Facebook Instagram A friend Email The Jewish Light Other (explain below) Explain here:Are you interested in learning more about Mirowitz?* Yes! No, thanks. Are you interested in learning more about PJ Library?* Yes! I already receive PJ Library books! No thanks! I am interested in events for Hebrew speakers.* Yes! No thanks! We will be taking pictures at the event!* Yes! You can post my child on social media (no names but you might see a nametag) No, please do not post my child on social media!
