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Young Philanthropists Registration

Teen Information:
First Name
Last Name
Child's Date of Birth (mm/dd/yyyy)
Grade
Teen Phone #
Parent's name(s)
Email
Cell Phone

Payment Details:
$36 Tzedakah Donation
 $36

Payment Information:
I am a member, charge my card on file
Card Type
Name on Card
Credit Card Number
CVV (located on back of card)
Expires (mm/yy)

The Merage JCC is a 501(C)(3) non-profit organization and all contributions are tax deductible to the full extent of the law. The JCC Federal Tax ID number is 330016661.