To preregister for a brit, complete the form below and click the send button. Cantor Kushner will contact you within a week to answer questions and address individual concerns. If you do not hear from him, it is possible that this form was not received, so please call him at 800-559-BRIS. When your son is born, use the 800 number to contact Cantor Kushner and schedule the brit. Parent's full name: Parent's Hebrew name: Parent is a: Click to Select Cohen Levi Yisrael Don't Know Parent's full name: Parent's Hebrew name: Parent is a: Click to Select Cohen Levi Yisrael Don't Know Email address: Address: City: State: Zip: Home phone: Cell: Due date: January February March April May June July August September October November December 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Having a boy?: Yes Don't know Hospital: Home nurse's name: Referred by: Congregation: Rabbi invited: Yes No Do you want CantorK to contact you?: No Yes Additional comments: Receipt for medical insurance reimbursement available upon request.