High Holiday Reservation Form

Full Name*
First Name Last Name
Phone Number*

Area Code Phone Number
E-mail*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

ROSH HASHANAH
Rosh Hashanah Eve - September 22*

Evening Service - 6:30pmUnable to Attend
Amount of Men RH Eve
Amount of Women RH Eve
Rosh Hashanah Day 1 - September 23* Click all options that apply

9:30am - 1:00pmShofar in Freedom Park 6:00pmUnable to attend
Amount of Men RH Day 1
Amount of Women RH Day 1
Children's Room Day 1 * Please note: All children need to be able to play properly in the playroom or a parent will have to remain with them to supervise. Children are not allowed to be playing in other areas of Chabad such as the library, lobby or kitchen.

My Children will utilize children's room - 10:30am - 1:00pm
Amount of Children / Grand Children (Day 1)
Rosh Hashanah Day 2 - September 24* Click all options that apply

9:30am - 1:00pmShofar in Freedom Park - 6:00pmUnable To Attend
Amount of Men RH Day 2
Amount of Women RH Day 2
Children's Room Day 2 *Please note: All children need to be able to play properly in the playroom or a parent will have to remain with them to supervise. Children are not allowed to be playing in other areas of Chabad such as the library, lobby or kitchen.

My Children will utilize children's room - 10:30am - 1:00pm
Amount of Children / Grand Children (Day 2)
SHABBAT SHUVA
Shabbat Services September 27*

9:30am - 12:00pmUnable to attend
YOM KIPPUR
Kol Nidrei - October 1*

6:30pmUnable to attend
Amount of Men Kol Nidrei
Amount of Women Kol Nidrei
Yom Kippur Day - October 1*

9:30am - 1:30pmUnable to Attend
Amount of Men YK Day
Amount of Women YK Day
Children's Room Yom Kippur * Please note: To ensure a safe and enjoyable environment for everyone, children must play in the playroom under appropriate supervision. If needed, a parent should remain with them to supervise. For safety reasons, children are not allowed to play in other areas of Chabad, including the library, lobby, and kitchen.

My Children will utilize children's room - 10:30am - 1:00pm
Amount of Children / Grandchildren Yom Kippur
Yom Kippur Afternoon - October 2*

Mincha & Neilah & Break fast Service 5:00pm - 7:19pmUnable to Attend
Amount of Men YK Afternoon
Amount of Women YK Afternoon
Please help our congregants with chemical sensitivities be safe at Chabad by avoiding perfumes, aftershaves and scented lotions when coming for services.*

I'm aware that Chabad in Medford is a Fragrance Free Environment.
High Holiday Donation (Optional)
Participation in all High Holiday programs is free. Please consider a donation to help cover the costs of these and other wonderful and vital programs that Chabad in Medford brings to our community.
Holiday Partnership

$36$54$72$118$180$360$540$720$1018$2500$3600$5400
In Honor or in Memory
Comments or Questions
Total

$0.00

Payment

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Postal / Zip Code

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Holiday Date

ROSH HASHANAH

SHABBAT SHUVA

YOM KIPPUR

High Holiday Donation (Optional)