Shabbat @Home

Name*
First Last
Email*
Cell Phone*
The Purim Kit will include a Mishloach Manot, candles, kiddush, challah, dips, sweet lukshin kugel, and Hamentashen for you to celebrate Purim and Shabbat at home!
I would like a Purim Kit for myself/my family*
- Yes
- No
Pick-up/Delivery for myself/my family*
- I can pick up from LifeTown on Thursday, February 25 (2:30-3:30pm))
- I am unable to leave my house and would appreciate a delivery
(Delivery is available only for seniors and homebound families in Livingston, West Orange, and Short Hills)
Address*
Street Address City

For Others
I would like to personally deliver a taste of Purim to a senior or homebound neighbor*
Pick up will be Thursday, February 25 from 2:30-3:30pm.
- Yes
- No

For me to deliver:*

Please list up to three friends to drop off packages to.

Name	Address	City

I would like FCNJ volunteers to deliver a taste of Purim to a senior or homebound neighbor*
- Yes
- No
(Delivery is available only for seniors and homebound families in Livingston, West Orange, and Short Hills)

For FCNJ to deliver:*

Please list up to three friends for FCNJ to deliver packages to.

Name	Address	City

For Others