Enrollment
MailChimp Tag / Form Name
Memo
Notes to internal Federation professionals
Parent / Guardian Name
*
First Name
Last Name
Parent / Guardian Email
*
Confirmation Email
Confirm email address
Parent / Guardian Mobile Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Date of Birth
-
Month
-
Day
Year
Please provide full name and date of birth for each child in your household.
*
How did you hear about PJ Library books? (check all that apply)
Email
Print advertisement
Patch Ad
PJ Library Newsletter
Social media
Friend / family member
Word of mouth
Federation Weekly Round-up
Other
Who referred you?
*
Please check to confirm the following three terms and agreements:
*
I confirm that the address entered is primarily where the child/children reside.
I confirm that my family includes Jewish member(s) and is eligible for PJ Library.
I agree to receive future information about the program and accept the terms of PJ Library’s
Privacy Policy
. I understand that I may opt out at any time.
SUBMIT
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