Family Name  
 

Home Address  Cell Phone  

Email Address   
 

Fathers Name   Mothers Name

Child 1    Child 2 

Child 3    Child 4  
 

Number of Adults Attending :                            1 2 3 4 5   $25.00 per adult

Number of Children Attending (Ages 3 -13):      1 2 3 4 5 6   $12.00 per child

Number of Adults & Children (Ages 5+) Attending:     1 2 3 4 5 6 7 8 9 10  $45 per person

Number of Children (Ages 2-4) Attending:                  1 2 3 4 5  $25 per person

Price Includes Prepared Boxed Lunch (includes wrap of your choice plus chips, fruit, and a cookie)

Please choose amount of each:  Turkey Wraps 0 1 2 3 4 5 6       Tuna Wraps 0 1 2 3 4 5 6       Grilled Veggie Wraps  0 1 2 3 4 5 6

Please make sure to download, fill out and bring the Snowtubing release with you on 2/26/17.

SNOWTUBING RELEASE FORM 
 

Payment Method                                  Please Choose Pay Later by Check Pay Now by Credit Card    Amount: $

Card Type             Choose Type Visa Mastercard Amex Discover   Card# 

Exp Date:                             01 02 03 04 05 06 07 08 09 10 11 12 Month /                    Year 2018 2019 2020 2021 2022 2023  CVV Code  (3 digits on back) 
(Amex: 4 digits above # on front)
 

I agree that my child(ren) will be supervised by a parent or another adult that is on the trip.  This outing is a family event coordinated by Chabad of Bethesda, but each family is responsible for their own child(ren). I give permission to allow my child(ren) to be photographed while participating in in these activities and that these pictures may be used for marketing purposes.

I Agree