English Name *

First Name

Last Name

Relationship to Mother/Father

Son of

Daughter of

Your Name *

First Name

Last Name

List the English Name in the Newsletter? *

We normally will list both the Hebrew and English names in our weekly bulletin. If you prefer, we can list only the Hebrew name for privacy. Or, you may decide not to list the name at all in the bulletin.

Yes

No

Do not put in the weekly bulletin, only for mishaberach.