ETY Fall Fest 2024

CONTACT INFORMATION

Parent First Name

Parent Last Name

Parent Phone Number

Parent Email Address

Child's First Name

Child's Last Name

Child's Grade

2nd Grade3rd Grade4th Grade

My child will attend this program at?
(please select the location where your child goes to Religious School)

JBSC - October 27Temple - November 3

ACCOMMODATIONS

Do your child need any accommodations to allow full participation in this event?

YesNo

What accommodations do they need?

DIETARY CONCERNS

As a Reform Jewish congregation, WHC does not serve pork, shellfish, or anything that combines meat and dairy. However we do order from restaurants and caterers that are are not kosher.

In addition, we always have a vegetarian option available.

Does your child have allergies?

Please let us know any additional information about allergies or food restrictions

Child count

TOTAL COST

Subtotal (formSubtotal)

Admin Code (Staff Use Only)

Enter Admin Code

Amount Due Today (DiscountTotal)

Would you like to make a donation? Enter the amount below. Donations to the Lewis S. Wiener Annual Fund support the Temple's greatest financial need.

This donation is from:

Total Amount (TotalAmount)

Refund policy

PAYMENT METHOD

How would you like to pay your bill?

Credit Card (includes 3% fee)ACH (Direct Bank Debit - No fee)

CREDIT CARD INFORMATION

To help defray some of WHC's credit card processing costs, a 3% fee has been added to your credit card payment. Please note that ACH payments do not include this fee.

Fee Amount

Grand Total

First Name on Card

Last Name on Card

Credit Card Number

Expiration Month

Expiration Year

CVV

Billing Street

Billing City

Billing State

Billing Zip Code

ACH INFORMATION

Personal check with labels for routing and account numbers

Bank Routing Number

Bank Account Number

Bank Account Type

CheckingSavings

Bank Name

Account Holder's Name (NOTE: If this is a joint account, use one name only. If it's a trust/foundation use one first/last name only)

Billing Street

Billing City

Billing State

Billing Zip Code

Publicly Hidden Fields

Payment Section

Hide Payment Info

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Portal Pre-Fill Fields

Account ID

Contact ID

Outreach/Event Pre-Fill

OutreachID

DesignationID

Auth.net Connector Billing Info

Gateway Address

Gateway City

Gateway State

Gateway Zip

Gateway Totals

Gateway Quantity

Gateway Amount

Click SUBMIT only once to avoid being charged multiple times.

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