Registration - Chabad Jewish Center

Address*

Home Phone
Area CodePhone Number
Mother's Cell Phone*
Area CodePhone Number
Father's Cell Phone
Area CodePhone Number
E-mail*
I would like to receive news and updates by email
Are there any adoptions or conversions in the family? (If yes, please describe in comments below)*
NoYes
Comments
Is there any information concerning your child that is important for the directors of Mommy & Me to know (ex: asthma, food allergies, adoptions, ect...)
Agreement*
All registrations are pending administrative review and space availability. If we are not able to accept your registration, you will be refunded in full.
Date & Time*
MonthDayYear
at HourMinutes
Signature*
First NameLast Name
Registration Options
Number of Individual Classes$15 per session
Full Season Options$120 per season
Fall 2019Spring 2020
Total
$0.00

Payment

Credit Card Check or Cash

Postal / Zip Code

Country

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