Choleh’s Confidential Information Choleh’s Jewish Name Ben/Bas --Select One-- Ben (Son Of) Bas (Daughter Of) Mother’s Jewish Name Age City/State Choleh is your: --Select One-- Child Father Friend Grandparent Mother Relative Self Sibling Spouse Other Choleh’s Diagnosis: Comments or any additional information: Your E-mail address: Confirm E-mail: I understand that all information pertaining to this choleh (except location) will be given to the people who adopt the name to help personalize their tefillos Please do not give out any personal information regarding this choleh
Choleh’s Jewish Name
Ben/Bas --Select One-- Ben (Son Of) Bas (Daughter Of)
