Contact Information
First
*
Last
*
Address
*
City
*
State
*
Zip
*
Phone
*
Email
*
Payment Details
Select Amount
$72 - 4 x Chai
Sponsor a child for a day
$360 - 20 x Chai
Sponsor a child for one week
$1,440 - 80 x Chai
Sponsor a child for the summer
$54 - 3 x Chai
Sponsor Shabbos Party
Other
*
Purpose
Purpose
Camp Scholarship Donation
Tuition
Kosher Meals
Comments
Type
Card Type
Visa
MC
Amex
Discover
*
Number
*
Expiration
Month
1 - January
2 - February
3 - March
4 - April
5 - May
6 - June
7 - July
8 - August
9 - September
10 - October
11 - November
12 - December
*
Year
2025
2026
2027
2028
2029
2030
2031
2032
2033
2034
2035
2036
2037
*
Code
*
Use contact info above.
Name
*
Address
*
Zip
*
Submit