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Main Street, Sharon\u0026nbsp;\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\n\u003cp\u003e\u003cstrong\u003eRegister today to ensure a Jewish tomorrow!\u003c/strong\u003e\u003c/p\u003e\n\n\u003cp\u003ePlease complete the form below.\u003c/p\u003e\n\n\u003cp\u003eIf you have any questions, feel free to contact Chanie Minkowitz at 781-363-7053 or Chanie@SharonFriends.com.\u003c/p\u003e\n","24_name":"doubleclickTo","24_qid":24,"24_type":"control_text","24_order":1,"6_text":"Section 1. 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Number"},"5_readonly":"No","5_name":"cell","5_qid":5,"5_type":"control_phone","5_order":5,"3_receivesReceipts":"No","3_text":"Email","3_message":"","3_labelAlign":"Auto","3_required":"Yes","3_size":30,"3_validation":"Email","3_maxsize":"","3_defaultValue":"","3_subLabel":"","3_hint":" ","3_description":"","3_confirmation":"No","3_confirmationHint":"Confirm Email","3_readonly":"No","3_name":"email","3_qid":3,"3_type":"control_email","3_order":6,"25_text":"Mailing Address","25_message":"","25_labelAlign":"Auto","25_required":"Yes","25_selectedCountry":"United States","25_description":"","25_subfields":"st1|city|state|zip|country","25_sublabels":{"cc_firstName":"First Name","cc_lastName":"Last Name","cc_number":"Credit Card Number","cc_ccv":"Security Code","cc_exp_month":"Expiration Month","cc_exp_year":"Expiration Year","addr_line1":"Street Address","addr_line2":"Street Address Line 2","city":"City","state":"State / Province","postal":"Postal / Zip Code","country":"Country"},"25_name":"mailingAddress","25_qid":25,"25_type":"control_address","25_order":7,"25_shrink":"No","26_text":"Hebrew Name","26_message":"","26_labelAlign":"Auto","26_required":"No","26_size":20,"26_validation":"None","26_maxsize":"","26_inputTextMask":"","26_defaultValue":"","26_subLabel":"","26_hint":" ","26_description":"","26_readonly":"No","26_name":"hebrewName26","26_qid":26,"26_type":"control_textbox","26_order":8,"27_text":"Home Number","27_message":"","27_labelAlign":"Auto","27_required":"No","27_validation":"Numeric","27_countryCode":"No","27_inputMask":"disable","27_inputMaskValue":"(###) ###-####","27_description":"","27_sublabels":{"country":"Country Code","area":"Area Code","phone":"Phone Number","full":"Phone Number"},"27_readonly":"No","27_name":"homeNumber","27_qid":27,"27_type":"control_phone","27_order":9,"69_text":"Parent 2","69_subHeader":"","69_headerType":"Small","69_name":"clickTo69","69_qid":69,"69_type":"control_head","69_order":10,"28_text":"Name","28_message":"","28_labelAlign":"Auto","28_required":"No","28_prefix":"No","28_suffix":"No","28_middle":"No","28_description":"","28_sublabels":{"prefix":"Prefix","first":"First Name","middle":"Middle Name","last":"Last Name","suffix":"Suffix"},"28_readonly":"No","28_name":"name28","28_qid":28,"28_type":"control_fullname","28_order":11,"29_text":"Cell","29_message":"","29_labelAlign":"Auto","29_required":"No","29_validation":"Numeric","29_countryCode":"No","29_inputMask":"disable","29_inputMaskValue":"(###) ###-####","29_description":"","29_sublabels":{"country":"Country Code","area":"Area Code","phone":"Phone Number","full":"Phone Number"},"29_readonly":"No","29_name":"cell29","29_qid":29,"29_type":"control_phone","29_order":12,"30_receivesReceipts":"No","30_text":"E-mail","30_message":"","30_labelAlign":"Auto","30_required":"No","30_size":30,"30_validation":"Email","30_maxsize":"","30_defaultValue":"","30_subLabel":"","30_hint":" ","30_description":"","30_confirmation":"No","30_confirmationHint":"Confirm Email","30_readonly":"No","30_name":"email30","30_qid":30,"30_type":"control_email","30_order":13,"31_text":"Mailing Address (if different than above)","31_message":"","31_labelAlign":"Auto","31_required":"No","31_selectedCountry":"United States","31_description":"if different than above","31_subfields":"st1|city|state|zip|country","31_sublabels":{"cc_firstName":"First Name","cc_lastName":"Last Name","cc_number":"Credit Card Number","cc_ccv":"Security Code","cc_exp_month":"Expiration Month","cc_exp_year":"Expiration Year","addr_line1":"Street Address","addr_line2":"Street Address Line 2","city":"City","state":"State / Province","postal":"Postal / Zip Code","country":"Country"},"31_name":"mailingAddress31","31_qid":31,"31_type":"control_address","31_order":14,"31_shrink":"No","32_text":"Hebrew Name","32_message":"","32_labelAlign":"Auto","32_required":"No","32_size":20,"32_validation":"None","32_maxsize":"","32_inputTextMask":"","32_defaultValue":"","32_subLabel":"","32_hint":" ","32_description":"","32_readonly":"No","32_name":"hebrewName32","32_qid":32,"32_type":"control_textbox","32_order":15,"34_text":"Home Number","34_message":"","34_labelAlign":"Auto","34_required":"No","34_validation":"Numeric","34_countryCode":"No","34_inputMask":"disable","34_inputMaskValue":"(###) ###-####","34_description":"if different than above","34_sublabels":{"country":"Country Code","area":"Area Code","phone":"Phone Number","full":"Phone Number"},"34_readonly":"No","34_name":"homeNumber34","34_qid":34,"34_type":"control_phone","34_order":16,"35_text":"Marital Status","35_message":"","35_labelAlign":"Auto","35_required":"No","35_options":"Married |Divorced ","35_special":"None","35_allowOther":"Yes","35_otherText":"Other","35_calculateOther":"No","35_selected":"","35_spreadCols":"1","35_description":"","35_name":"maritalStatus","35_qid":35,"35_type":"control_radio","35_order":17,"36_text":"Synagogue Affiliation","36_message":"","36_labelAlign":"Auto","36_required":"No","36_size":20,"36_validation":"None","36_maxsize":"","36_inputTextMask":"","36_defaultValue":"","36_subLabel":"","36_hint":" ","36_description":"","36_readonly":"No","36_name":"synagogueAffiliation","36_qid":36,"36_type":"control_textbox","36_order":18,"90_text":"Amount of Children to register","90_message":"","90_labelAlign":"Auto","90_required":"No","90_options":"1|2|3","90_special":"None","90_size":0,"90_width":150,"90_selected":"1","90_subLabel":"","90_description":"","90_emptyText":"","90_name":"amountOf90","90_qid":90,"90_type":"control_dropdown","90_order":19,"90_pricing":"50|100|150","37_text":"Were the child(ren), mother and maternal grandmother all born Jewish?","37_message":"","37_labelAlign":"Top","37_required":"Yes","37_options":"Yes|No, (Please explain below)","37_special":"None","37_allowOther":"No","37_otherText":"Yes, Please explain","37_calculateOther":"No","37_selected":"","37_spreadCols":"1","37_description":"","37_name":"wereThere","37_qid":37,"37_type":"control_radio","37_order":20,"37_shrink":"Yes","85_text":"Conversion or adoption information","85_message":"","85_labelAlign":"Auto","85_required":"No","85_size":20,"85_validation":"None","85_maxsize":"","85_inputTextMask":"","85_defaultValue":"","85_subLabel":"","85_hint":" ","85_description":"","85_readonly":"No","85_name":"input85","85_qid":85,"85_type":"control_textbox","85_order":21,"7_text":"Section 2. Child\u0027s Information","7_subHeader":"","7_headerType":"Default","7_name":"clickTo7","7_qid":7,"7_type":"control_head","7_order":22,"39_text":"Child\u0027s Name","39_message":"","39_labelAlign":"Auto","39_required":"Yes","39_prefix":"No","39_suffix":"No","39_middle":"No","39_description":"","39_sublabels":{"prefix":"Prefix","first":"First Name","middle":"Middle Name","last":"Last Name","suffix":"Suffix"},"39_readonly":"No","39_name":"childsName","39_qid":39,"39_type":"control_fullname","39_order":23,"42_text":"Grade Entering","42_message":"","42_labelAlign":"Auto","42_required":"Yes","42_options":"Kindergarten|1st Grade|2nd Grade|3rd Grade|4th Grade|5th Grade|6th Grade|7th Grade","42_special":"None","42_size":0,"42_width":150,"42_selected":"","42_subLabel":"","42_description":"","42_emptyText":"","42_name":"gradeEntering","42_qid":42,"42_type":"control_dropdown","42_order":24,"73_text":"Birth Date","73_message":"","73_labelAlign":"Auto","73_required":"Yes","73_format":"mmddyyyy","73_yearFrom":"","73_yearTo":"","73_months":[[],[],[],[],[],[],[],[],[],[],[],[]],"73_description":"","73_sublabels":{"month":"Month","day":"Day","year":"Year"},"73_name":"birthDate73","73_qid":73,"73_type":"control_birthdate","73_order":25,"40_text":"Hebrew Name","40_message":"","40_labelAlign":"Auto","40_required":"No","40_size":20,"40_validation":"None","40_maxsize":"","40_inputTextMask":"","40_defaultValue":"","40_subLabel":"","40_hint":" ","40_description":"","40_readonly":"No","40_name":"hebrewName","40_qid":40,"40_type":"control_textbox","40_order":26,"70_text":"Child 2","70_subHeader":"","70_headerType":"Default","70_name":"clickTo70","70_qid":70,"70_type":"control_head","70_order":27,"76_text":"Child\u0027s Name","76_message":"","76_labelAlign":"Auto","76_required":"No","76_prefix":"No","76_suffix":"No","76_middle":"No","76_description":"","76_sublabels":{"prefix":"Prefix","first":"First Name","middle":"Middle Name","last":"Last Name","suffix":"Suffix"},"76_readonly":"No","76_name":"childsName76","76_qid":76,"76_type":"control_fullname","76_order":28,"72_text":"Grade Entering","72_message":"","72_labelAlign":"Auto","72_required":"No","72_options":"Kindergarten|1st Grade|2nd Grade|3rd Grade|4th Grade|5th Grade|6th Grade|7th Grade","72_special":"None","72_size":0,"72_width":150,"72_selected":"","72_subLabel":"","72_description":"","72_emptyText":"","72_name":"gradeEntering72","72_qid":72,"72_type":"control_dropdown","72_order":29,"44_text":"Birth Date","44_message":"","44_labelAlign":"Auto","44_required":"No","44_format":"mmddyyyy","44_yearFrom":"","44_yearTo":"","44_months":[[],[],[],[],[],[],[],[],[],[],[],[]],"44_description":"","44_sublabels":{"month":"Month","day":"Day","year":"Year"},"44_name":"birthDate44","44_qid":44,"44_type":"control_birthdate","44_order":30,"74_text":"Hebrew Name","74_message":"","74_labelAlign":"Auto","74_required":"No","74_size":20,"74_validation":"None","74_maxsize":"","74_inputTextMask":"","74_defaultValue":"","74_subLabel":"","74_hint":" ","74_description":"","74_readonly":"No","74_name":"hebrewName74","74_qid":74,"74_type":"control_textbox","74_order":31,"75_text":"Child 3","75_subHeader":"","75_headerType":"Default","75_name":"clickTo75","75_qid":75,"75_type":"control_head","75_order":32,"71_text":"Child\u0027s Name","71_message":"","71_labelAlign":"Auto","71_required":"No","71_prefix":"No","71_suffix":"No","71_middle":"No","71_description":"","71_sublabels":{"prefix":"Prefix","first":"First Name","middle":"Middle Name","last":"Last Name","suffix":"Suffix"},"71_readonly":"No","71_name":"childsName71","71_qid":71,"71_type":"control_fullname","71_order":33,"81_text":"Grade Entering","81_message":"","81_labelAlign":"Auto","81_required":"No","81_options":"Kindergarten|1st Grade|2nd Grade|3rd Grade|4th Grade|5th Grade|6th Grade|7th Grade","81_special":"None","81_size":0,"81_width":150,"81_selected":"","81_subLabel":"","81_description":"","81_emptyText":"","81_name":"gradeEntering81","81_qid":81,"81_type":"control_dropdown","81_order":34,"78_text":"Birth Date","78_message":"","78_labelAlign":"Auto","78_required":"No","78_format":"mmddyyyy","78_yearFrom":"","78_yearTo":"","78_months":[[],[],[],[],[],[],[],[],[],[],[],[]],"78_description":"","78_sublabels":{"month":"Month","day":"Day","year":"Year"},"78_name":"birthDate78","78_qid":78,"78_type":"control_birthdate","78_order":35,"79_text":"Hebrew Name","79_message":"","79_labelAlign":"Auto","79_required":"No","79_size":20,"79_validation":"None","79_maxsize":"","79_inputTextMask":"","79_defaultValue":"","79_subLabel":"","79_hint":" ","79_description":"","79_readonly":"No","79_name":"hebrewName79","79_qid":79,"79_type":"control_textbox","79_order":36,"45_text":"3. Emergency Information","45_subHeader":"","45_headerType":"Default","45_name":"clickTo45","45_qid":45,"45_type":"control_head","45_order":37,"77_text":"Emergency Contact","77_message":"","77_labelAlign":"Auto","77_required":"Yes","77_prefix":"No","77_suffix":"No","77_middle":"No","77_description":"(Other than parents)","77_sublabels":{"prefix":"Prefix","first":"First Name","middle":"Middle Name","last":"Last Name","suffix":"Suffix"},"77_readonly":"No","77_name":"emergencyContact77","77_qid":77,"77_type":"control_fullname","77_order":38,"47_text":"Phone Number","47_message":"","47_labelAlign":"Auto","47_required":"Yes","47_validation":"Numeric","47_countryCode":"No","47_inputMask":"disable","47_inputMaskValue":"(###) ###-####","47_description":"","47_sublabels":{"country":"Country Code","area":"Area Code","phone":"Phone Number","full":"Phone Number"},"47_readonly":"No","47_name":"phoneNumber","47_qid":47,"47_type":"control_phone","47_order":39,"48_text":"Relationship to Child","48_message":"","48_labelAlign":"Auto","48_required":"No","48_size":20,"48_validation":"None","48_maxsize":"","48_inputTextMask":"","48_defaultValue":"","48_subLabel":"","48_hint":" ","48_description":"","48_readonly":"No","48_name":"relationshipTo","48_qid":48,"48_type":"control_textbox","48_order":40,"49_text":"Does your child have allergies? (Food or medication)","49_message":"","49_labelAlign":"Top","49_required":"Yes","49_options":"No|Yes, (Please List Below)","49_special":"None","49_allowOther":"No","49_otherText":"Yes, Please List","49_calculateOther":"No","49_selected":"","49_spreadCols":"1","49_description":"","49_name":"doesYour","49_qid":49,"49_type":"control_radio","49_order":41,"49_shrink":"Yes","86_text":"Allergies:","86_message":"","86_labelAlign":"Auto","86_required":"No","86_size":20,"86_validation":"None","86_maxsize":"","86_inputTextMask":"","86_defaultValue":"","86_subLabel":"","86_hint":" ","86_description":"","86_readonly":"No","86_name":"input86","86_qid":86,"86_type":"control_textbox","86_order":42,"50_text":"Does your child take medication regularly?","50_message":"","50_labelAlign":"Top","50_required":"Yes","50_options":"No|Yes,  (please explain below)","50_special":"None","50_allowOther":"No","50_otherText":"Yes, What Kind?","50_calculateOther":"No","50_selected":"","50_spreadCols":"1","50_description":"","50_name":"doesYour50","50_qid":50,"50_type":"control_radio","50_order":43,"50_shrink":"Yes","87_text":"Medication Info:","87_message":"","87_labelAlign":"Auto","87_required":"No","87_size":20,"87_validation":"None","87_maxsize":"","87_inputTextMask":"","87_defaultValue":"","87_subLabel":"","87_hint":" ","87_description":"","87_readonly":"No","87_name":"input87","87_qid":87,"87_type":"control_textbox","87_order":44,"51_text":"Any special needs (physical, developmental, learning, emotional, behavioral) that may require special awareness on the part of our staff.","51_message":"","51_labelAlign":"Top","51_required":"Yes","51_options":"N/A|Yes, (Please list below)","51_special":"None","51_allowOther":"No","51_otherText":"Please list here","51_calculateOther":"No","51_selected":"","51_spreadCols":"1","51_description":"","51_name":"pleaseList51","51_qid":51,"51_type":"control_radio","51_order":45,"51_shrink":"No","51_newLine":"Yes","89_text":"Special needs:","89_message":"","89_labelAlign":"Auto","89_required":"No","89_size":20,"89_validation":"None","89_maxsize":"","89_inputTextMask":"","89_defaultValue":"","89_subLabel":"","89_hint":" ","89_description":"","89_readonly":"No","89_name":"input89","89_qid":89,"89_type":"control_textbox","89_order":46,"52_text":"Does your child have an IEP? ","52_message":"","52_labelAlign":"Top","52_required":"Yes","52_options":"No|Yes","52_special":"None","52_allowOther":"No","52_otherText":"Please submit","52_calculateOther":"No","52_selected":"","52_spreadCols":"1","52_description":"","52_name":"doesYour52","52_qid":52,"52_type":"control_radio","52_order":47,"52_shrink":"Yes","20_text":"4. Dates and Rates","20_subHeader":"","20_headerType":"Default","20_name":"clickTo20","20_qid":20,"20_type":"control_head","20_order":48,"54_text":"\u003cp\u003e\u003cstrong\u003eDates:\u003c/strong\u003e The 2026-2027\u0026nbsp;school year begins on October 11,\u0026nbsp;2026. The last day is on May 23, 2027. Our calendar generally follows the Sharon Public School schedule for seasonal breaks and weekends off. Be sure to check the Hebrew School calendar. Click \u003ca href=\"/article.asp?AID=7447684\"\u003ehere \u003c/a\u003efor the PDF Calendar.\u0026nbsp;\u003cbr\u003e\n\u003cbr\u003e\n\u003cstrong\u003eRates: \u003c/strong\u003eNon refundable\u0026nbsp;registration fee ($25) \u0026amp; book fee ($25) per child due upon registration: $50\u003c/p\u003e\n\n\u003ctable bgcolor=\"FFFFFF\" border=\"0\" cellpadding=\"10\" cellspacing=\"0\" dir=\"ltr\" style=\"\" width=\"100%\"\u003e\n\t\u003ctbody\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd bgcolor=\"#CAC9CA\" style=\"color: #CAC9CA\" width=\"25%\"\u003e.\u003c/td\u003e\n\t\t\t\u003ctd bgcolor=\"#CAC9CA\" width=\"25%\"\u003e\u003cspan class=\"style8\" style=\"font-family: Tahoma;\"\u003eGrade\u003c/span\u003e\u003c/td\u003e\n\t\t\t\u003ctd bgcolor=\"#CAC9CA\" width=\"25%\"\u003e\u003cspan class=\"style8\" style=\"font-family: Tahoma;\"\u003eEarly bird - before September 11, 2026\u003c/span\u003e\u003c/td\u003e\n\t\t\t\u003ctd bgcolor=\"#CAC9CA\" width=\"25%\"\u003e\u003cspan class=\"style8\" style=\"font-family: Tahoma;\"\u003eAfter September 11, 2026\u003c/span\u003e\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\t\u003ctd bgcolor=\"#F0F0F0\"\u003e\u003cstrong\u003e\u003cspan style=\"font-family: Tahoma;\"\u003eTuition Fees\u003c/span\u003e\u003c/strong\u003e\u003c/td\u003e\n\t\t\t\u003ctd bgcolor=\"#F0F0F0\"\u003e\u003cspan class=\"style3\" style=\"font-family: Tahoma;\"\u003eKindergarten - 6th grade\u003c/span\u003e\u003c/td\u003e\n\t\t\t\u003ctd bgcolor=\"#F0F0F0\"\u003e\u003cspan class=\"style3\" style=\"font-family: Tahoma;\"\u003e$999\u003c/span\u003e\u003c/td\u003e\n\t\t\t\u003ctd bgcolor=\"#F0F0F0\"\u003e\u003cspan class=\"style3\" style=\"font-family: Tahoma;\"\u003e$1099\u003c/span\u003e\u003c/td\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\u003c/tr\u003e\n\t\t\u003ctr\u003e\n\t\t\u003c/tr\u003e\n\t\u003c/tbody\u003e\n\u003c/table\u003e\n","54_name":"doubleclickTo54","54_qid":54,"54_type":"control_text","54_order":49,"55_text":"Payments are due the first of each month. Please choose your choice of payment:","55_message":"","55_labelAlign":"Top","55_required":"Yes","55_options":"I will submit seven checks, dated the first of each month, October- May (Monthly tuition amount: Early bird: $142/month. Regular: $157/month)|Charge my credit card on the first of each month, October- May. (Monthly tuition amount: Early bird: $142/month. Regular: $157/month)","55_special":"None","55_allowOther":"No","55_otherText":"Other","55_calculateOther":"No","55_selected":"","55_spreadCols":"1","55_description":"","55_name":"input55","55_qid":55,"55_type":"control_radio","55_order":50,"55_shrink":"Yes","55_pricing":"||0|","53_text":"5. Payment Options","53_subHeader":"","53_headerType":"Default","53_name":"clickTo53","53_qid":53,"53_type":"control_head","53_order":51,"91_text":"Please tick your rate box","91_message":"","91_labelAlign":"Auto","91_required":"Yes","91_options":"Early bird $999 before September 11, 2026|Regular rate: $1099 after September 11, 2026","91_special":"None","91_allowOther":"No","91_otherText":"Other","91_calculateOther":"No","91_spreadCols":"1","91_selected":"","91_minSelection":"","91_maxSelection":"","91_description":"","91_name":"input91","91_qid":91,"91_type":"control_checkbox","91_order":52,"94_text":"\u003cp\u003eRefer a friend and receive $50 off your tuition! 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<form class="userform-form" action="" method="post" name="form_5205262" id="5205262" accept-charset="utf-8"><input type="hidden" name="formID" value="5205262" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li class="form-line" id="id_24"><div id="cid_24" class="form-input-wide"> <div id="text_24" class="form-html"><p><img alt="" height="425" src="https://w2.chabad.org/media/images/1376/tGUd13769764.png" style="float:right" width="550" /></p>

<p><strong>Welcome to Chabad Hebrew School 2026!</strong></p>

<p><strong>First day of Classes, Sunday, October 11</strong></p>

<p><strong>Hebrew School is on Sundays from 10:30am- 12:00pm </strong></p>

<p><strong>Location: Chabad of Sharon Function Hall (Back Building) 162 N. Main Street, Sharon  </strong></p>

<p><strong>Register today to ensure a Jewish tomorrow!</strong></p>

<p>Please complete the form below.</p>

<p>If you have any questions, feel free to contact Chanie Minkowitz at 781-363-7053 or Chanie@SharonFriends.com.</p>
</div> </div></li><li id="cid_6" class="form-input-wide"> <div class="form-header-group"><h2 id="header_6" class="form-header">Section 1. Parent's Infomation</h2></div> </li><li id="cid_68" class="form-input-wide"> <div class="form-header-group"><h3 id="header_68" class="form-header">Parent 1</h3></div> </li><li class="form-line" id="id_1"><div class="form-label-left" id="label_1"><label for="input_1"> Name<span class="form-required">*</span> </label><label class="label-message" for="input_1"> </label></div><div id="cid_1" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q1_name[first]" id="first_1" autocomplete="given-name" />  <label class="form-sub-label" for="first_1" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q1_name[last]" id="last_1" autocomplete="family-name" />  <label class="form-sub-label" for="last_1" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_5"><div class="form-label-left" id="label_5"><label for="input_5"> Cell<span class="form-required">*</span> </label><label class="label-message" for="input_5"> </label></div><div id="cid_5" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q5_cell[area]" id="input_5_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_5_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q5_cell[phone]" id="input_5_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_5_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_3"><div class="form-label-left" id="label_3"><label for="input_3"> Email<span class="form-required">*</span> </label><label class="label-message" for="input_3"> </label></div><div id="cid_3" class="form-input"> <input type="email" class=" form-textbox validate[required, Email]" id="input_3" name="q3_email" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_25"><div class="form-label-left" id="label_25"><label for="input_25"> Mailing Address<span class="form-required">*</span> </label><label class="label-message" for="input_25"> </label></div><div id="cid_25" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-line" type="text" name="q25_mailingAddress[addr_line1]" id="input_25_addr_line1" size="46" autocomplete="address-line1" />  <label class="form-sub-label" for="input_25_addr_line1" id="sublabel_25_addr_line1">Street Address</label></span></td></tr><tr style="display: none;"><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line no-validation" type="text" name="q25_mailingAddress[addr_line2]" id="input_25_addr_line2" size="46" autocomplete="address-line2" />  <label class="form-sub-label" for="input_25_addr_line2" id="sublabel_25_addr_line2">Street Address Line 2</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-city" type="text" name="q25_mailingAddress[city]" id="input_25_city" size="21" autocomplete="address-level2" />  <label class="form-sub-label" for="input_25_city" id="sublabel_25_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-state" type="text" name="q25_mailingAddress[state]" id="input_25_state" size="22" autocomplete="address-level1" />  <label class="form-sub-label" for="input_25_state" id="sublabel_25_state">State / Province</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-postal" type="text" name="q25_mailingAddress[postal]" id="input_25_postal" size="10" autocomplete="postal-code" />  <label class="form-sub-label" for="input_25_postal" id="sublabel_25_postal">Postal / Zip Code</label></span></td><td><span class="form-sub-label-container"><select class="form-dropdown validate[required] form-address-country" name="q25_mailingAddress[country]" id="input_25_country" autocomplete="country-name"><option value="" selected="selected">Please Select</option><option selected="selected" value="United States">United States</option><option value="Afghanistan">Afghanistan</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Anguilla">Anguilla</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</option><option value="Australia">Australia</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="The Bahamas">The Bahamas</option><option value="Bahrain">Bahrain</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option value="Bermuda">Bermuda</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option><option value="Botswana">Botswana</option><option value="Brazil">Brazil</option><option value="Brunei">Brunei</option><option value="Bulgaria">Bulgaria</option><option value="Burkina Faso">Burkina Faso</option><option value="Burundi">Burundi</option><option value="Cambodia">Cambodia</option><option value="Cameroon">Cameroon</option><option value="Canada">Canada</option><option value="Cape Verde">Cape Verde</option><option value="Cayman Islands">Cayman Islands</option><option value="Central African Republic">Central African Republic</option><option value="Chad">Chad</option><option value="Chile">Chile</option><option value="People's Republic of China">People's Republic of China</option><option value="Republic of China">Republic of China</option><option value="Christmas Island">Christmas Island</option><option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option><option value="Colombia">Colombia</option><option value="Comoros">Comoros</option><option value="Congo">Congo</option><option value="Cook Islands">Cook Islands</option><option value="Costa Rica">Costa Rica</option><option value="Cote d'Ivoire">Cote d'Ivoire</option><option value="Croatia">Croatia</option><option value="Cuba">Cuba</option><option value="Cyprus">Cyprus</option><option value="Czech Republic">Czech Republic</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic">Dominican Republic</option><option value="Ecuador">Ecuador</option><option value="Egypt">Egypt</option><option value="El Salvador">El Salvador</option><option value="Equatorial Guinea">Equatorial Guinea</option><option value="Eritrea">Eritrea</option><option value="Estonia">Estonia</option><option value="Eswatini">Eswatini</option><option value="Ethiopia">Ethiopia</option><option value="Falkland Islands">Falkland Islands</option><option value="Faroe Islands">Faroe Islands</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="French Polynesia">French Polynesia</option><option value="Gabon">Gabon</option><option value="The Gambia">The Gambia</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Gibraltar">Gibraltar</option><option value="Greece">Greece</option><option value="Greenland">Greenland</option><option value="Grenada">Grenada</option><option value="Guadeloupe">Guadeloupe</option><option value="Guam">Guam</option><option value="Guatemala">Guatemala</option><option value="Guernsey">Guernsey</option><option value="Guinea">Guinea</option><option value="Guinea-Bissau">Guinea-Bissau</option><option value="Guyana">Guyana</option><option value="Haiti">Haiti</option><option value="Honduras">Honduras</option><option value="Hong Kong">Hong Kong</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Indonesia">Indonesia</option><option value="Iran">Iran</option><option value="Iraq">Iraq</option><option value="Ireland">Ireland</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jersey">Jersey</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kiribati">Kiribati</option><option value="North Korea">North Korea</option><option value="South Korea">South Korea</option><option value="Kosovo">Kosovo</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Laos">Laos</option><option value="Latvia">Latvia</option><option value="Lebanon">Lebanon</option><option value="Lesotho">Lesotho</option><option value="Liberia">Liberia</option><option value="Libya">Libya</option><option value="Liechtenstein">Liechtenstein</option><option value="Lithuania">Lithuania</option><option value="Luxembourg">Luxembourg</option><option value="Macau">Macau</option><option value="Macedonia">Macedonia</option><option value="Madagascar">Madagascar</option><option value="Malawi">Malawi</option><option value="Malaysia">Malaysia</option><option value="Maldives">Maldives</option><option value="Mali">Mali</option><option value="Malta">Malta</option><option value="Marshall Islands">Marshall Islands</option><option value="Martinique">Martinique</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mayotte">Mayotte</option><option value="Mexico">Mexico</option><option value="Micronesia">Micronesia</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Montserrat">Montserrat</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Myanmar">Myanmar</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Nepal">Nepal</option><option value="Netherlands">Netherlands</option><option value="New Caledonia">New Caledonia</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger">Niger</option><option value="Nigeria">Nigeria</option><option value="Niue">Niue</option><option value="Norfolk Island">Norfolk Island</option><option value="Northern Mariana">Northern Mariana</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palau">Palau</option><option value="Panama">Panama</option><option value="Papua New Guinea">Papua New Guinea</option><option value="Paraguay">Paraguay</option><option value="Peru">Peru</option><option value="Philippines">Philippines</option><option value="Pitcairn Islands">Pitcairn Islands</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Romania">Romania</option><option value="Russia">Russia</option><option value="Rwanda">Rwanda</option><option value="Saint Barthelemy">Saint Barthelemy</option><option value="Saint Helena">Saint Helena</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Martin">Saint Martin</option><option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option><option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome and Principe">Sao Tome and Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Slovakia">Slovakia</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="Somaliland">Somaliland</option><option value="South Africa">South Africa</option><option value="South Ossetia">South Ossetia</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Svalbard">Svalbard</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syria">Syria</option><option value="Taiwan">Taiwan</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Thailand">Thailand</option><option value="Timor-Leste">Timor-Leste</option><option value="Togo">Togo</option><option value="Tokelau">Tokelau</option><option value="Tonga">Tonga</option><option value="Trinidad and Tobago">Trinidad and Tobago</option><option value="Tristan da Cunha">Tristan da Cunha</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="Turkmenistan">Turkmenistan</option><option value="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Vatican City">Vatican City</option><option value="Venezuela">Venezuela</option><option value="Vietnam">Vietnam</option><option value="British Virgin Islands">British Virgin Islands</option><option value="US Virgin Islands">US Virgin Islands</option><option value="Wallis and Futuna">Wallis and Futuna</option><option value="Western Sahara">Western Sahara</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option><option value="other">Other</option></select>  <label class="form-sub-label" for="input_25_country" id="sublabel_25_country">Country</label></span></td></tr></tbody></table> </div></li><li class="form-line" id="id_26"><div class="form-label-left" id="label_26"><label for="input_26"> Hebrew Name </label><label class="label-message" for="input_26"> </label></div><div id="cid_26" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_26" name="q26_hebrewName26" size="20" value="" /> </div></li><li class="form-line" id="id_27"><div class="form-label-left" id="label_27"><label for="input_27"> Home Number </label><label class="label-message" for="input_27"> </label></div><div id="cid_27" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q27_homeNumber[area]" id="input_27_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_27_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q27_homeNumber[phone]" id="input_27_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_27_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li id="cid_69" class="form-input-wide"> <div class="form-header-group"><h3 id="header_69" class="form-header">Parent 2</h3></div> </li><li class="form-line" id="id_28"><div class="form-label-left" id="label_28"><label for="input_28"> Name </label><label class="label-message" for="input_28"> </label></div><div id="cid_28" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox" type="text" size="10" name="q28_name28[first]" id="first_28" autocomplete="given-name" />  <label class="form-sub-label" for="first_28" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox" type="text" size="15" name="q28_name28[last]" id="last_28" autocomplete="family-name" />  <label class="form-sub-label" for="last_28" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_29"><div class="form-label-left" id="label_29"><label for="input_29"> Cell </label><label class="label-message" for="input_29"> </label></div><div id="cid_29" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q29_cell29[area]" id="input_29_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_29_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q29_cell29[phone]" id="input_29_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_29_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_30"><div class="form-label-left" id="label_30"><label for="input_30"> E-mail </label><label class="label-message" for="input_30"> </label></div><div id="cid_30" class="form-input"> <input type="email" class=" form-textbox validate[Email]" id="input_30" name="q30_email30" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_31"><div class="form-label-left" id="label_31"><label for="input_31"> Mailing Address (if different than above) </label><label class="label-message" for="input_31"> </label></div><div id="cid_31" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line" type="text" name="q31_mailingAddress31[addr_line1]" id="input_31_addr_line1" size="46" autocomplete="address-line1" />  <label class="form-sub-label" for="input_31_addr_line1" id="sublabel_31_addr_line1">Street Address</label></span></td></tr><tr style="display: none;"><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line no-validation" type="text" name="q31_mailingAddress31[addr_line2]" id="input_31_addr_line2" size="46" autocomplete="address-line2" />  <label class="form-sub-label" for="input_31_addr_line2" id="sublabel_31_addr_line2">Street Address Line 2</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-city" type="text" name="q31_mailingAddress31[city]" id="input_31_city" size="21" autocomplete="address-level2" />  <label class="form-sub-label" for="input_31_city" id="sublabel_31_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox form-address-state" type="text" name="q31_mailingAddress31[state]" id="input_31_state" size="22" autocomplete="address-level1" />  <label class="form-sub-label" for="input_31_state" id="sublabel_31_state">State / Province</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-postal" type="text" name="q31_mailingAddress31[postal]" id="input_31_postal" size="10" autocomplete="postal-code" />  <label class="form-sub-label" for="input_31_postal" id="sublabel_31_postal">Postal / Zip Code</label></span></td><td><span class="form-sub-label-container"><select class="form-dropdown form-address-country" name="q31_mailingAddress31[country]" id="input_31_country" autocomplete="country-name"><option value="" selected="selected">Please Select</option><option selected="selected" value="United States">United States</option><option value="Afghanistan">Afghanistan</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Anguilla">Anguilla</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</option><option value="Australia">Australia</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="The Bahamas">The Bahamas</option><option value="Bahrain">Bahrain</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option value="Bermuda">Bermuda</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option><option value="Botswana">Botswana</option><option value="Brazil">Brazil</option><option value="Brunei">Brunei</option><option value="Bulgaria">Bulgaria</option><option value="Burkina Faso">Burkina Faso</option><option value="Burundi">Burundi</option><option value="Cambodia">Cambodia</option><option value="Cameroon">Cameroon</option><option value="Canada">Canada</option><option value="Cape Verde">Cape Verde</option><option value="Cayman Islands">Cayman Islands</option><option value="Central African Republic">Central African Republic</option><option value="Chad">Chad</option><option value="Chile">Chile</option><option value="People's Republic of China">People's Republic of China</option><option value="Republic of China">Republic of China</option><option value="Christmas Island">Christmas Island</option><option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option><option value="Colombia">Colombia</option><option value="Comoros">Comoros</option><option value="Congo">Congo</option><option value="Cook Islands">Cook Islands</option><option value="Costa Rica">Costa Rica</option><option value="Cote d'Ivoire">Cote d'Ivoire</option><option value="Croatia">Croatia</option><option value="Cuba">Cuba</option><option value="Cyprus">Cyprus</option><option value="Czech Republic">Czech Republic</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic">Dominican Republic</option><option value="Ecuador">Ecuador</option><option value="Egypt">Egypt</option><option value="El Salvador">El Salvador</option><option value="Equatorial Guinea">Equatorial Guinea</option><option value="Eritrea">Eritrea</option><option value="Estonia">Estonia</option><option value="Eswatini">Eswatini</option><option value="Ethiopia">Ethiopia</option><option value="Falkland Islands">Falkland Islands</option><option value="Faroe Islands">Faroe Islands</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="French Polynesia">French Polynesia</option><option value="Gabon">Gabon</option><option value="The Gambia">The Gambia</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Gibraltar">Gibraltar</option><option value="Greece">Greece</option><option value="Greenland">Greenland</option><option value="Grenada">Grenada</option><option value="Guadeloupe">Guadeloupe</option><option value="Guam">Guam</option><option value="Guatemala">Guatemala</option><option value="Guernsey">Guernsey</option><option value="Guinea">Guinea</option><option value="Guinea-Bissau">Guinea-Bissau</option><option value="Guyana">Guyana</option><option value="Haiti">Haiti</option><option value="Honduras">Honduras</option><option value="Hong Kong">Hong Kong</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Indonesia">Indonesia</option><option value="Iran">Iran</option><option value="Iraq">Iraq</option><option value="Ireland">Ireland</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jersey">Jersey</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kiribati">Kiribati</option><option value="North Korea">North Korea</option><option value="South Korea">South Korea</option><option value="Kosovo">Kosovo</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Laos">Laos</option><option value="Latvia">Latvia</option><option value="Lebanon">Lebanon</option><option value="Lesotho">Lesotho</option><option value="Liberia">Liberia</option><option value="Libya">Libya</option><option value="Liechtenstein">Liechtenstein</option><option value="Lithuania">Lithuania</option><option value="Luxembourg">Luxembourg</option><option value="Macau">Macau</option><option value="Macedonia">Macedonia</option><option value="Madagascar">Madagascar</option><option value="Malawi">Malawi</option><option value="Malaysia">Malaysia</option><option value="Maldives">Maldives</option><option value="Mali">Mali</option><option value="Malta">Malta</option><option value="Marshall Islands">Marshall Islands</option><option value="Martinique">Martinique</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mayotte">Mayotte</option><option value="Mexico">Mexico</option><option value="Micronesia">Micronesia</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Montserrat">Montserrat</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Myanmar">Myanmar</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Nepal">Nepal</option><option value="Netherlands">Netherlands</option><option value="New Caledonia">New Caledonia</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger">Niger</option><option value="Nigeria">Nigeria</option><option value="Niue">Niue</option><option value="Norfolk Island">Norfolk Island</option><option value="Northern Mariana">Northern Mariana</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palau">Palau</option><option value="Panama">Panama</option><option value="Papua New Guinea">Papua New Guinea</option><option value="Paraguay">Paraguay</option><option value="Peru">Peru</option><option value="Philippines">Philippines</option><option value="Pitcairn Islands">Pitcairn Islands</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Romania">Romania</option><option value="Russia">Russia</option><option value="Rwanda">Rwanda</option><option value="Saint Barthelemy">Saint Barthelemy</option><option value="Saint Helena">Saint Helena</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Martin">Saint Martin</option><option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option><option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome and Principe">Sao Tome and Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Slovakia">Slovakia</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="Somaliland">Somaliland</option><option value="South Africa">South Africa</option><option value="South Ossetia">South Ossetia</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Svalbard">Svalbard</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syria">Syria</option><option value="Taiwan">Taiwan</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Thailand">Thailand</option><option value="Timor-Leste">Timor-Leste</option><option value="Togo">Togo</option><option value="Tokelau">Tokelau</option><option value="Tonga">Tonga</option><option value="Trinidad and Tobago">Trinidad and Tobago</option><option value="Tristan da Cunha">Tristan da Cunha</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="Turkmenistan">Turkmenistan</option><option value="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Vatican City">Vatican City</option><option value="Venezuela">Venezuela</option><option value="Vietnam">Vietnam</option><option value="British Virgin Islands">British Virgin Islands</option><option value="US Virgin Islands">US Virgin Islands</option><option value="Wallis and Futuna">Wallis and Futuna</option><option value="Western Sahara">Western Sahara</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option><option value="other">Other</option></select>  <label class="form-sub-label" for="input_31_country" id="sublabel_31_country">Country</label></span></td></tr></tbody></table> </div></li><li class="form-line" id="id_32"><div class="form-label-left" id="label_32"><label for="input_32"> Hebrew Name </label><label class="label-message" for="input_32"> </label></div><div id="cid_32" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_32" name="q32_hebrewName32" size="20" value="" /> </div></li><li class="form-line" id="id_34"><div class="form-label-left" id="label_34"><label for="input_34"> Home Number </label><label class="label-message" for="input_34"> </label></div><div id="cid_34" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q34_homeNumber34[area]" id="input_34_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_34_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q34_homeNumber34[phone]" id="input_34_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_34_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_35"><div class="form-label-left" id="label_35"><label for="input_35"> Marital Status </label><label class="label-message" for="input_35"> </label></div><div id="cid_35" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_35_0" name="q35_maritalStatus" value="Married" /><label id="label_input_35_0" for="input_35_0"><span>Married</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_35_1" name="q35_maritalStatus" value="Divorced" /><label id="label_input_35_1" for="input_35_1"><span>Divorced</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio-other form-radio validate[other]" name="q35_maritalStatus" id="other_35" value="" /><span><input type="text" class="form-radio-other-input form-textbox form-radio validate[other]" name="q35_maritalStatus[other]" data-otherhint="Other" size="15" id="input_35" disabled="disabled" /></span><br /></span></div> </div></li><li class="form-line" id="id_36"><div class="form-label-left" id="label_36"><label for="input_36"> Synagogue Affiliation </label><label class="label-message" for="input_36"> </label></div><div id="cid_36" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_36" name="q36_synagogueAffiliation" size="20" value="" /> </div></li><li class="form-line" id="id_90"><div class="form-label-left" id="label_90"><label for="input_90"> Amount of Children to register </label><label class="label-message" for="input_90"> </label></div><div id="cid_90" class="form-input"> <select class="form-dropdown" style="width:150px" id="input_90" name="q90_amountOf90"><option value=""></option><option selected="selected" value="1">1</option><option value="2">2</option><option value="3">3</option></select> </div></li><li class="form-line" id="id_37"><div class="form-label-left" id="label_37"><label for="input_37"> Were the child(ren), mother and maternal grandmother all born Jewish?<span class="form-required">*</span> </label><label class="label-message" for="input_37"> </label></div><div id="cid_37" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_37_0" name="q37_wereThere" value="Yes" /><label id="label_input_37_0" for="input_37_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_37_1" name="q37_wereThere" value="No, (Please explain below)" /><label id="label_input_37_1" for="input_37_1"><span>No, (Please explain below)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_85"><div class="form-label-left" id="label_85"><label for="input_85"> Conversion or adoption information </label><label class="label-message" for="input_85"> </label></div><div id="cid_85" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_85" name="q85_input85" size="20" value="" /> </div></li><li id="cid_7" class="form-input-wide"> <div class="form-header-group"><h2 id="header_7" class="form-header">Section 2. Child's Information</h2></div> </li><li class="form-line" id="id_39"><div class="form-label-left" id="label_39"><label for="input_39"> Child's Name<span class="form-required">*</span> </label><label class="label-message" for="input_39"> </label></div><div id="cid_39" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q39_childsName[first]" id="first_39" autocomplete="given-name" />  <label class="form-sub-label" for="first_39" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q39_childsName[last]" id="last_39" autocomplete="family-name" />  <label class="form-sub-label" for="last_39" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_42"><div class="form-label-left" id="label_42"><label for="input_42"> Grade Entering<span class="form-required">*</span> </label><label class="label-message" for="input_42"> </label></div><div id="cid_42" class="form-input"> <select class="form-dropdown validate[required]" style="width:150px" id="input_42" name="q42_gradeEntering"><option value=""></option><option value="Kindergarten">Kindergarten</option><option value="1st Grade">1st Grade</option><option value="2nd Grade">2nd Grade</option><option value="3rd Grade">3rd Grade</option><option value="4th Grade">4th Grade</option><option value="5th Grade">5th Grade</option><option value="6th Grade">6th Grade</option><option value="7th Grade">7th Grade</option></select> </div></li><li class="form-line" id="id_73"><div class="form-label-left" id="label_73"><label for="input_73"> Birth Date<span class="form-required">*</span> </label><label class="label-message" for="input_73"> </label></div><div id="cid_73" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q73_birthDate73[month]" id="input_73_month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_73_month" id="sublabel_month">Month</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q73_birthDate73[day]" id="input_73_day"><option></option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option><option value="13">13</option><option value="14">14</option><option value="15">15</option><option value="16">16</option><option value="17">17</option><option value="18">18</option><option value="19">19</option><option value="20">20</option><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option></select>  <label class="form-sub-label" for="input_73_day" id="sublabel_day">Day</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q73_birthDate73[year]" id="input_73_year"><option></option><option value="2026">2026</option><option value="2025">2025</option><option value="2024">2024</option><option value="2023">2023</option><option value="2022">2022</option><option value="2021">2021</option><option value="2020">2020</option><option value="2019">2019</option><option value="2018">2018</option><option value="2017">2017</option><option value="2016">2016</option><option value="2015">2015</option><option value="2014">2014</option><option value="2013">2013</option><option value="2012">2012</option><option value="2011">2011</option><option value="2010">2010</option><option value="2009">2009</option><option value="2008">2008</option><option value="2007">2007</option><option value="2006">2006</option><option value="2005">2005</option><option value="2004">2004</option><option value="2003">2003</option><option value="2002">2002</option><option value="2001">2001</option><option value="2000">2000</option><option value="1999">1999</option><option value="1998">1998</option><option value="1997">1997</option><option value="1996">1996</option><option value="1995">1995</option><option value="1994">1994</option><option value="1993">1993</option><option value="1992">1992</option><option value="1991">1991</option><option value="1990">1990</option><option value="1989">1989</option><option value="1988">1988</option><option value="1987">1987</option><option value="1986">1986</option><option value="1985">1985</option><option value="1984">1984</option><option value="1983">1983</option><option value="1982">1982</option><option value="1981">1981</option><option value="1980">1980</option><option value="1979">1979</option><option value="1978">1978</option><option value="1977">1977</option><option value="1976">1976</option><option value="1975">1975</option><option value="1974">1974</option><option value="1973">1973</option><option value="1972">1972</option><option value="1971">1971</option><option value="1970">1970</option><option value="1969">1969</option><option value="1968">1968</option><option value="1967">1967</option><option value="1966">1966</option><option value="1965">1965</option><option value="1964">1964</option><option value="1963">1963</option><option value="1962">1962</option><option value="1961">1961</option><option value="1960">1960</option><option value="1959">1959</option><option value="1958">1958</option><option value="1957">1957</option><option value="1956">1956</option><option value="1955">1955</option><option value="1954">1954</option><option value="1953">1953</option><option value="1952">1952</option><option value="1951">1951</option><option value="1950">1950</option><option value="1949">1949</option><option value="1948">1948</option><option value="1947">1947</option><option value="1946">1946</option><option value="1945">1945</option><option value="1944">1944</option><option value="1943">1943</option><option value="1942">1942</option><option value="1941">1941</option><option value="1940">1940</option><option value="1939">1939</option><option value="1938">1938</option><option value="1937">1937</option><option value="1936">1936</option><option value="1935">1935</option><option value="1934">1934</option><option value="1933">1933</option><option value="1932">1932</option><option value="1931">1931</option><option value="1930">1930</option><option value="1929">1929</option><option value="1928">1928</option><option value="1927">1927</option><option value="1926">1926</option><option value="1925">1925</option><option value="1924">1924</option><option value="1923">1923</option><option value="1922">1922</option><option value="1921">1921</option><option value="1920">1920</option></select>  <label class="form-sub-label" for="input_73_year" id="sublabel_year">Year</label></span></div> </div></li><li class="form-line" id="id_40"><div class="form-label-left" id="label_40"><label for="input_40"> Hebrew Name </label><label class="label-message" for="input_40"> </label></div><div id="cid_40" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_40" name="q40_hebrewName" size="20" value="" /> </div></li><li id="cid_70" class="form-input-wide"> <div class="form-header-group"><h2 id="header_70" class="form-header">Child 2</h2></div> </li><li class="form-line" id="id_76"><div class="form-label-left" id="label_76"><label for="input_76"> Child's Name </label><label class="label-message" for="input_76"> </label></div><div id="cid_76" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox" type="text" size="10" name="q76_childsName76[first]" id="first_76" autocomplete="given-name" />  <label class="form-sub-label" for="first_76" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox" type="text" size="15" name="q76_childsName76[last]" id="last_76" autocomplete="family-name" />  <label class="form-sub-label" for="last_76" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_72"><div class="form-label-left" id="label_72"><label for="input_72"> Grade Entering </label><label class="label-message" for="input_72"> </label></div><div id="cid_72" class="form-input"> <select class="form-dropdown" style="width:150px" id="input_72" name="q72_gradeEntering72"><option value=""></option><option value="Kindergarten">Kindergarten</option><option value="1st Grade">1st Grade</option><option value="2nd Grade">2nd Grade</option><option value="3rd Grade">3rd Grade</option><option value="4th Grade">4th Grade</option><option value="5th Grade">5th Grade</option><option value="6th Grade">6th Grade</option><option value="7th Grade">7th Grade</option></select> </div></li><li class="form-line" id="id_44"><div class="form-label-left" id="label_44"><label for="input_44"> Birth Date </label><label class="label-message" for="input_44"> </label></div><div id="cid_44" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown" name="q44_birthDate44[month]" id="input_44_month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_44_month" id="sublabel_month">Month</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown" name="q44_birthDate44[day]" id="input_44_day"><option></option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option><option value="13">13</option><option value="14">14</option><option value="15">15</option><option value="16">16</option><option value="17">17</option><option value="18">18</option><option value="19">19</option><option value="20">20</option><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option></select>  <label class="form-sub-label" for="input_44_day" id="sublabel_day">Day</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown" name="q44_birthDate44[year]" id="input_44_year"><option></option><option value="2026">2026</option><option value="2025">2025</option><option value="2024">2024</option><option value="2023">2023</option><option value="2022">2022</option><option value="2021">2021</option><option value="2020">2020</option><option value="2019">2019</option><option value="2018">2018</option><option value="2017">2017</option><option value="2016">2016</option><option value="2015">2015</option><option value="2014">2014</option><option value="2013">2013</option><option value="2012">2012</option><option value="2011">2011</option><option value="2010">2010</option><option value="2009">2009</option><option value="2008">2008</option><option value="2007">2007</option><option value="2006">2006</option><option value="2005">2005</option><option value="2004">2004</option><option value="2003">2003</option><option value="2002">2002</option><option value="2001">2001</option><option value="2000">2000</option><option value="1999">1999</option><option value="1998">1998</option><option value="1997">1997</option><option value="1996">1996</option><option value="1995">1995</option><option value="1994">1994</option><option value="1993">1993</option><option value="1992">1992</option><option value="1991">1991</option><option value="1990">1990</option><option value="1989">1989</option><option value="1988">1988</option><option value="1987">1987</option><option value="1986">1986</option><option value="1985">1985</option><option value="1984">1984</option><option value="1983">1983</option><option value="1982">1982</option><option value="1981">1981</option><option value="1980">1980</option><option value="1979">1979</option><option value="1978">1978</option><option value="1977">1977</option><option value="1976">1976</option><option value="1975">1975</option><option value="1974">1974</option><option value="1973">1973</option><option value="1972">1972</option><option value="1971">1971</option><option value="1970">1970</option><option value="1969">1969</option><option value="1968">1968</option><option value="1967">1967</option><option value="1966">1966</option><option value="1965">1965</option><option value="1964">1964</option><option value="1963">1963</option><option value="1962">1962</option><option value="1961">1961</option><option value="1960">1960</option><option value="1959">1959</option><option value="1958">1958</option><option value="1957">1957</option><option value="1956">1956</option><option value="1955">1955</option><option value="1954">1954</option><option value="1953">1953</option><option value="1952">1952</option><option value="1951">1951</option><option value="1950">1950</option><option value="1949">1949</option><option value="1948">1948</option><option value="1947">1947</option><option value="1946">1946</option><option value="1945">1945</option><option value="1944">1944</option><option value="1943">1943</option><option value="1942">1942</option><option value="1941">1941</option><option value="1940">1940</option><option value="1939">1939</option><option value="1938">1938</option><option value="1937">1937</option><option value="1936">1936</option><option value="1935">1935</option><option value="1934">1934</option><option value="1933">1933</option><option value="1932">1932</option><option value="1931">1931</option><option value="1930">1930</option><option value="1929">1929</option><option value="1928">1928</option><option value="1927">1927</option><option value="1926">1926</option><option value="1925">1925</option><option value="1924">1924</option><option value="1923">1923</option><option value="1922">1922</option><option value="1921">1921</option><option value="1920">1920</option></select>  <label class="form-sub-label" for="input_44_year" id="sublabel_year">Year</label></span></div> </div></li><li class="form-line" id="id_74"><div class="form-label-left" id="label_74"><label for="input_74"> Hebrew Name </label><label class="label-message" for="input_74"> </label></div><div id="cid_74" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_74" name="q74_hebrewName74" size="20" value="" /> </div></li><li id="cid_75" class="form-input-wide"> <div class="form-header-group"><h2 id="header_75" class="form-header">Child 3</h2></div> </li><li class="form-line" id="id_71"><div class="form-label-left" id="label_71"><label for="input_71"> Child's Name </label><label class="label-message" for="input_71"> </label></div><div id="cid_71" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox" type="text" size="10" name="q71_childsName71[first]" id="first_71" autocomplete="given-name" />  <label class="form-sub-label" for="first_71" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox" type="text" size="15" name="q71_childsName71[last]" id="last_71" autocomplete="family-name" />  <label class="form-sub-label" for="last_71" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_81"><div class="form-label-left" id="label_81"><label for="input_81"> Grade Entering </label><label class="label-message" for="input_81"> </label></div><div id="cid_81" class="form-input"> <select class="form-dropdown" style="width:150px" id="input_81" name="q81_gradeEntering81"><option value=""></option><option value="Kindergarten">Kindergarten</option><option value="1st Grade">1st Grade</option><option value="2nd Grade">2nd Grade</option><option value="3rd Grade">3rd Grade</option><option value="4th Grade">4th Grade</option><option value="5th Grade">5th Grade</option><option value="6th Grade">6th Grade</option><option value="7th Grade">7th Grade</option></select> </div></li><li class="form-line" id="id_78"><div class="form-label-left" id="label_78"><label for="input_78"> Birth Date </label><label class="label-message" for="input_78"> </label></div><div id="cid_78" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown" name="q78_birthDate78[month]" id="input_78_month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_78_month" id="sublabel_month">Month</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown" name="q78_birthDate78[day]" id="input_78_day"><option></option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option><option value="13">13</option><option value="14">14</option><option value="15">15</option><option value="16">16</option><option value="17">17</option><option value="18">18</option><option value="19">19</option><option value="20">20</option><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option></select>  <label class="form-sub-label" for="input_78_day" id="sublabel_day">Day</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown" name="q78_birthDate78[year]" id="input_78_year"><option></option><option value="2026">2026</option><option value="2025">2025</option><option value="2024">2024</option><option value="2023">2023</option><option value="2022">2022</option><option value="2021">2021</option><option value="2020">2020</option><option value="2019">2019</option><option value="2018">2018</option><option value="2017">2017</option><option value="2016">2016</option><option value="2015">2015</option><option value="2014">2014</option><option value="2013">2013</option><option value="2012">2012</option><option value="2011">2011</option><option value="2010">2010</option><option value="2009">2009</option><option value="2008">2008</option><option value="2007">2007</option><option value="2006">2006</option><option value="2005">2005</option><option value="2004">2004</option><option value="2003">2003</option><option value="2002">2002</option><option value="2001">2001</option><option value="2000">2000</option><option value="1999">1999</option><option value="1998">1998</option><option value="1997">1997</option><option value="1996">1996</option><option value="1995">1995</option><option value="1994">1994</option><option value="1993">1993</option><option value="1992">1992</option><option value="1991">1991</option><option value="1990">1990</option><option value="1989">1989</option><option value="1988">1988</option><option value="1987">1987</option><option value="1986">1986</option><option value="1985">1985</option><option value="1984">1984</option><option value="1983">1983</option><option value="1982">1982</option><option value="1981">1981</option><option value="1980">1980</option><option value="1979">1979</option><option value="1978">1978</option><option value="1977">1977</option><option value="1976">1976</option><option value="1975">1975</option><option value="1974">1974</option><option value="1973">1973</option><option value="1972">1972</option><option value="1971">1971</option><option value="1970">1970</option><option value="1969">1969</option><option value="1968">1968</option><option value="1967">1967</option><option value="1966">1966</option><option value="1965">1965</option><option value="1964">1964</option><option value="1963">1963</option><option value="1962">1962</option><option value="1961">1961</option><option value="1960">1960</option><option value="1959">1959</option><option value="1958">1958</option><option value="1957">1957</option><option value="1956">1956</option><option value="1955">1955</option><option value="1954">1954</option><option value="1953">1953</option><option value="1952">1952</option><option value="1951">1951</option><option value="1950">1950</option><option value="1949">1949</option><option value="1948">1948</option><option value="1947">1947</option><option value="1946">1946</option><option value="1945">1945</option><option value="1944">1944</option><option value="1943">1943</option><option value="1942">1942</option><option value="1941">1941</option><option value="1940">1940</option><option value="1939">1939</option><option value="1938">1938</option><option value="1937">1937</option><option value="1936">1936</option><option value="1935">1935</option><option value="1934">1934</option><option value="1933">1933</option><option value="1932">1932</option><option value="1931">1931</option><option value="1930">1930</option><option value="1929">1929</option><option value="1928">1928</option><option value="1927">1927</option><option value="1926">1926</option><option value="1925">1925</option><option value="1924">1924</option><option value="1923">1923</option><option value="1922">1922</option><option value="1921">1921</option><option value="1920">1920</option></select>  <label class="form-sub-label" for="input_78_year" id="sublabel_year">Year</label></span></div> </div></li><li class="form-line" id="id_79"><div class="form-label-left" id="label_79"><label for="input_79"> Hebrew Name </label><label class="label-message" for="input_79"> </label></div><div id="cid_79" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_79" name="q79_hebrewName79" size="20" value="" /> </div></li><li id="cid_45" class="form-input-wide"> <div class="form-header-group"><h2 id="header_45" class="form-header">3. Emergency Information</h2></div> </li><li class="form-line" id="id_77"><div class="form-label-left" id="label_77"><label for="input_77"> Emergency Contact<span class="form-required">*</span> </label><label class="label-message" for="input_77"> </label></div><div id="cid_77" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q77_emergencyContact77[first]" id="first_77" autocomplete="given-name" />  <label class="form-sub-label" for="first_77" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q77_emergencyContact77[last]" id="last_77" autocomplete="family-name" />  <label class="form-sub-label" for="last_77" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_47"><div class="form-label-left" id="label_47"><label for="input_47"> Phone Number<span class="form-required">*</span> </label><label class="label-message" for="input_47"> </label></div><div id="cid_47" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q47_phoneNumber[area]" id="input_47_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_47_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q47_phoneNumber[phone]" id="input_47_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_47_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_48"><div class="form-label-left" id="label_48"><label for="input_48"> Relationship to Child </label><label class="label-message" for="input_48"> </label></div><div id="cid_48" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_48" name="q48_relationshipTo" size="20" value="" /> </div></li><li class="form-line" id="id_49"><div class="form-label-left" id="label_49"><label for="input_49"> Does your child have allergies? (Food or medication)<span class="form-required">*</span> </label><label class="label-message" for="input_49"> </label></div><div id="cid_49" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_49_0" name="q49_doesYour" value="No" /><label id="label_input_49_0" for="input_49_0"><span>No</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_49_1" name="q49_doesYour" value="Yes, (Please List Below)" /><label id="label_input_49_1" for="input_49_1"><span>Yes, (Please List Below)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_86"><div class="form-label-left" id="label_86"><label for="input_86"> Allergies: </label><label class="label-message" for="input_86"> </label></div><div id="cid_86" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_86" name="q86_input86" size="20" value="" /> </div></li><li class="form-line" id="id_50"><div class="form-label-left" id="label_50"><label for="input_50"> Does your child take medication regularly?<span class="form-required">*</span> </label><label class="label-message" for="input_50"> </label></div><div id="cid_50" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_50_0" name="q50_doesYour50" value="No" /><label id="label_input_50_0" for="input_50_0"><span>No</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_50_1" name="q50_doesYour50" value="Yes,  (please explain below)" /><label id="label_input_50_1" for="input_50_1"><span>Yes,  (please explain below)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_87"><div class="form-label-left" id="label_87"><label for="input_87"> Medication Info: </label><label class="label-message" for="input_87"> </label></div><div id="cid_87" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_87" name="q87_input87" size="20" value="" /> </div></li><li class="form-line" id="id_51"><div class="form-label-left" id="label_51"><label for="input_51"> Any special needs (physical, developmental, learning, emotional, behavioral) that may require special awareness on the part of our staff.<span class="form-required">*</span> </label><label class="label-message" for="input_51"> </label></div><div id="cid_51" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_51_0" name="q51_pleaseList51" value="N/A" /><label id="label_input_51_0" for="input_51_0"><span>N/A</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_51_1" name="q51_pleaseList51" value="Yes, (Please list below)" /><label id="label_input_51_1" for="input_51_1"><span>Yes, (Please list below)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_89"><div class="form-label-left" id="label_89"><label for="input_89"> Special needs: </label><label class="label-message" for="input_89"> </label></div><div id="cid_89" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_89" name="q89_input89" size="20" value="" /> </div></li><li class="form-line" id="id_52"><div class="form-label-left" id="label_52"><label for="input_52"> Does your child have an IEP? <span class="form-required">*</span> </label><label class="label-message" for="input_52"> </label></div><div id="cid_52" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_52_0" name="q52_doesYour52" value="No" /><label id="label_input_52_0" for="input_52_0"><span>No</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_52_1" name="q52_doesYour52" value="Yes" /><label id="label_input_52_1" for="input_52_1"><span>Yes</span></label></span><span class="clearfix"></span></div> </div></li><li id="cid_20" class="form-input-wide"> <div class="form-header-group"><h2 id="header_20" class="form-header">4. Dates and Rates</h2></div> </li><li class="form-line" id="id_54"><div id="cid_54" class="form-input-wide"> <div id="text_54" class="form-html"><p><strong>Dates:</strong> The 2026-2027 school year begins on October 11, 2026. The last day is on May 23, 2027. Our calendar generally follows the Sharon Public School schedule for seasonal breaks and weekends off. Be sure to check the Hebrew School calendar. Click <a href="/article.asp?AID=7447684">here </a>for the PDF Calendar. <br />
<br />
<strong>Rates: </strong>Non refundable registration fee ($25) &amp; book fee ($25) per child due upon registration: $50</p>

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			<td bgcolor="#CAC9CA" style="color: #CAC9CA" width="25%">.</td>
			<td bgcolor="#CAC9CA" width="25%"><span class="style8" style="font-family: Tahoma;">Grade</span></td>
			<td bgcolor="#CAC9CA" width="25%"><span class="style8" style="font-family: Tahoma;">Early bird - before September 11, 2026</span></td>
			<td bgcolor="#CAC9CA" width="25%"><span class="style8" style="font-family: Tahoma;">After September 11, 2026</span></td>
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			<td bgcolor="#F0F0F0"><strong><span style="font-family: Tahoma;">Tuition Fees</span></strong></td>
			<td bgcolor="#F0F0F0"><span class="style3" style="font-family: Tahoma;">Kindergarten - 6th grade</span></td>
			<td bgcolor="#F0F0F0"><span class="style3" style="font-family: Tahoma;">$999</span></td>
			<td bgcolor="#F0F0F0"><span class="style3" style="font-family: Tahoma;">$1099</span></td>
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</div> </div></li><li class="form-line" id="id_55"><div class="form-label-left" id="label_55"><label for="input_55"> Payments are due the first of each month. Please choose your choice of payment:<span class="form-required">*</span> </label><label class="label-message" for="input_55"> </label></div><div id="cid_55" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_55_0" name="q55_input55" value="I will submit seven checks, dated the first of each month, October- May (Monthly tuition amount: Early bird: $142/month. Regular: $157/month)" /><label id="label_input_55_0" for="input_55_0"><span>I will submit seven checks, dated the first of each month, October- May (Monthly tuition amount: Early bird: $142/month. Regular: $157/month)</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_55_1" name="q55_input55" value="Charge my credit card on the first of each month, October- May. (Monthly tuition amount: Early bird: $142/month. Regular: $157/month)" /><label id="label_input_55_1" for="input_55_1"><span>Charge my credit card on the first of each month, October- May. (Monthly tuition amount: Early bird: $142/month. Regular: $157/month)</span></label></span><span class="clearfix"></span></div> </div></li><li id="cid_53" class="form-input-wide"> <div class="form-header-group"><h2 id="header_53" class="form-header">5. Payment Options</h2></div> </li><li class="form-line" id="id_91"><div class="form-label-left" id="label_91"><label for="input_91"> Please tick your rate box<span class="form-required">*</span> </label><label class="label-message" for="input_91"> </label></div><div id="cid_91" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_91_0" name="q91_input91[]" value="Early bird $999 before September 11, 2026" /><label id="label_input_91_0" for="input_91_0"><span>Early bird $999 before September 11, 2026</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox validate[required]" id="input_91_1" name="q91_input91[]" value="Regular rate: $1099 after September 11, 2026" /><label id="label_input_91_1" for="input_91_1"><span>Regular rate: $1099 after September 11, 2026</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_94"><div id="cid_94" class="form-input-wide"> <div id="text_94" class="form-html"><p>Refer a friend and receive $50 off your tuition! Rolling enrollment - you can redeem this offer at any time!</p>
</div> </div></li><li class="form-line" id="id_95"><div class="form-label-left" id="label_95"><label for="input_95"> If relevant, list name of friend you referred </label><label class="label-message" for="input_95"> </label></div><div id="cid_95" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_95" name="q95_input95" size="20" value="" /> </div></li><li class="form-line always-hidden" id="id_56"><div class="form-label-left" id="label_56"><label for="input_56"> Dates </label><label class="label-message" for="input_56"> </label></div><div id="cid_56" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_56" name="q56_dates" size="20" value="" /> </div></li><li class="form-line always-hidden" id="id_57"><div class="form-label-left" id="label_57"><label for="input_57"> Amounts </label><label class="label-message" for="input_57"> </label></div><div id="cid_57" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_57" name="q57_amounts" size="20" value="" /> </div></li><li class="form-line" id="id_60"><div class="form-label-left" id="label_60"><label for="input_60"> Phone Number where you can be reached </label><label class="label-message" for="input_60"> </label></div><div id="cid_60" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q60_phoneNumber60[area]" id="input_60_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_60_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[Numeric]" type="tel" name="q60_phoneNumber60[phone]" id="input_60_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_60_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_82"><div class="form-label-left" id="label_82"><label for="input_82"> Registration fee amount be charged today </label></div><div id="cid_82" class="form-input"> <div id="total_amount">$50.00 </div> </div></li><li class="form-line" id="id_21"><div class="form-label-left" id="label_21"><label for="input_21"> Payment </label><label class="label-message" for="input_21"> </label></div><div id="cid_21" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2" class="form-payment-methods form-multiple-column"><span class="form-radio-item"><input class="paymentMethod form-radio validate[paymentMethod] form-radio" type="radio" id="input_21_creditCard" name="q21_payment21[payment_method]" value="creditCard" onclick="BuildSource.creditCard(this)" /><label for="input_21_creditCard">Credit Card</label> </span><span class="form-radio-item"><input class="paymentMethod form-radio validate[paymentMethod] form-radio" type="radio" id="input_21_other" name="q21_payment21[payment_method]" value="other" onclick="BuildSource.other(this)" /><label for="input_21_other">Check</label> </span></td></tr><tr class="credit_card hide"><th colspan="2">Credit Card</th></tr><tr class="credit_card hide"><td colspan="2" style="padding:0"><table cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container">  <label class="form-sub-label">We accept Visa, MasterCard, American Express, Discover</label></span><div class="cc-icons"><div class="cc-icon visa-icon"></div><div class="cc-icon mastercard-icon"></div><div class="cc-icon amex-icon"></div><div class="cc-icon discover-icon"></div></div><input type="hidden" name="q21_payment21[cc_type]" id="input_21_cc_type" value="" /></td></tr><tr><td><div class="cc-field-wrapper"><span class="form-sub-label-container"><input class="form-textbox form-creditcard js-cc-number validate[visible, creditcard]" type="text" name="q21_payment21[cc_number]" id="input_21_cc_number" autocomplete="cc-number" size="20" />  <label class="form-sub-label" for="input_21_cc_number" id="sublabel_cc_number">Credit Card Number</label></span></div></td><td class="cc_ccv "><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q21_payment21[cc_ccv]" id="input_21_cc_ccv" autocomplete="cc-csc" size="6" />  <label class="form-sub-label" for="input_21_cc_ccv" id="sublabel_cc_ccv">Security Code</label></span></td></tr><tr><td colspan="2" class="cc_name_on_card "><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q21_payment21[cc_nameOnCard]" id="input_21_cc_nameOnCard" autocomplete="cc-name" size="33" />  <label class="form-sub-label" for="input_21_cc_nameOnCard" id="sublabel_cc_nameOnCard">Name on Card</label></span></td></tr><tr class="credit_card hide"><td colspan=""><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q21_payment21[cc_exp_month]" id="input_21_cc_exp_month" autocomplete="cc-exp-month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_21_cc_exp_month" id="sublabel_cc_exp_month">Expiration Month</label></span></td><td><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q21_payment21[cc_exp_year]" id="input_21_cc_exp_year" autocomplete="cc-exp-year"><option></option><option value="2026">2026</option><option value="2027">2027</option><option value="2028">2028</option><option value="2029">2029</option><option value="2030">2030</option><option value="2031">2031</option><option value="2032">2032</option><option value="2033">2033</option><option value="2034">2034</option><option value="2035">2035</option></select>  <label class="form-sub-label" for="input_21_cc_exp_year" id="sublabel_cc_exp_year">Expiration Year</label></span></td></tr></tbody></table></td></tr><tr class="other hide"><td colspan="2"></td></tr></tbody></table> </div></li><li class="form-line" id="id_96"><div id="cid_96" class="form-input-wide"> <img alt="" class="form-image" border="0" src="https://www.chabad.org/images/logo.png" height="55" width="164" /> </div></li><li class="form-line" id="id_61"><div id="cid_61" class="form-input-wide"> <div id="text_61" class="form-html"><p><strong>Cancelation Policy:</strong> On or before December 1, 2026, 50% refund; after December 2, 2026 30% refund.<br />
(There is no refund for registration fee or daily absences)</p>
</div> </div></li><li id="cid_62" class="form-input-wide"> <div class="form-header-group"><h2 id="header_62" class="form-header">6. Permission Form</h2></div> </li><li class="form-line" id="id_63"><div id="cid_63" class="form-input-wide"> <div id="text_63" class="form-html"><p>I hereby give permission for my child to participate in all Hebrew School activities.  </p>

<p>I understand my child may be injured by accident. I give Rabbi Naftoli &amp; Chanie Minkowitz and all the Hebrew School staff permission to attend to any injury in an appropriate manner and render any necessary first aid. In case of emergency, I authorize Rabbi Naftoli &amp; Chanie Minkowitz and the Hebrew School staff to call 911 and transport my child to the closest hospital and take the necessary medical care that the situation calls for. I understand the staff will use their best judgment and provide the appropriate care and will contact the emergency contact as soon as possible.  </p>
</div> </div></li><li class="form-line" id="id_92"><div class="form-label-left" id="label_92"><label for="input_92"> Check the box to affirm your permission.  </label><label class="label-message" for="input_92"> </label></div><div id="cid_92" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_92_0" name="q92_input92[]" value="I allow my child's picture to be posted on social media. This helps us share the fun your children have at Hebrew School with you and friends! We appreciate allowing your child to be on social media." /><label id="label_input_92_0" for="input_92_0"><span>I allow my child's picture to be posted on social media. This helps us share the fun your children have at Hebrew School with you and friends! We appreciate allowing your child to be on social media.</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_64"><div class="form-label-left" id="label_64"><label for="input_64"> Parent's Signature<span class="form-required">*</span> </label><label class="label-message" for="input_64"> </label></div><div id="cid_64" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_64" name="q64_parentsSignature" size="20" value="" /> </div></li><li class="form-line" id="id_65"><div class="form-label-left" id="label_65"><label for="input_65"> Date </label><label class="label-message" for="input_65"> </label></div><div id="cid_65" class="form-input"> <div class="datetime-fields"><div class="dir_ltr date-fields"><span class="form-sub-label-container"><input autocomplete="nope" class="form-textbox" id="month_65" name="q65_date[month]" type="tel" size="2" maxlength="2" value="07" />  <label class="form-sub-label" for="month_65" id="sublabel_month">Month</label></span><span class="form-sub-label-container"><input autocomplete="nope" class="form-textbox" id="day_65" name="q65_date[day]" type="tel" size="2" maxlength="2" value="28" />  <label class="form-sub-label" for="day_65" id="sublabel_day">Day</label></span><span class="form-sub-label-container"><input autocomplete="nope" class="form-textbox" id="year_65" name="q65_date[year]" type="tel" size="4" maxlength="4" value="2026" />  <label class="form-sub-label" for="year_65" id="sublabel_year">Year</label></span><span class="form-sub-label-container"><img class="showAutoCalendar" alt="Pick a Date" id="input_65_pick" src="https://w2.chabad.org/images/sitecontrol/formbuilder/calendar.png" align="absmiddle" />  <label class="form-sub-label" for="input_65_pick"><span> </span></label></span></div></div> </div></li><li class="form-line" id="id_19"><div class="form-label-left" id="label_19"><label for="input_19"> Comments / Questions </label><label class="label-message" for="input_19"> </label></div><div id="cid_19" class="form-input"> <textarea id="input_19" class="form-textarea" name="q19_comments" cols="40" rows="2"></textarea> </div></li><li class="form-line" id="id_2"><div id="cid_2" class="form-input-wide"> <div style="text-align: center; text-indent:156px;" class="form-buttons-wrapper button-align-auto"><button id="input_2" type="submit" class="form-submit-button  form-submit-button-none;">Submit</button></div> </div></li><li style="display:none">Should be Empty: <input type="text" name="website" value="" /></li></ul></div><input type="hidden" id="simple_spc" name="simple_spc" value="5205262" /><script type="text/javascript">document.getElementById("si"+"mple"+"_spc").value = "5205262-5205262";</script><div>


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