Mommy and Me Registration

MOMMY AND ME REGISTRATION
Child's Name*

First Name Last Name
Hebrew Name*
Birth Date*

Month Day Year
DayCare (if Applicable)*
Additional notable Information
Parents Information
Father's Name*

First Name Last Name
Father Cell

Area Code Phone Number
E-mail*

Both Parents Receive Email Receipts
Mother's Name*

First Name Last Name
Mother Cell

Area Code Phone Number
E-mail*

Both Parents Receive Email Receipts
Payment

First payment required via the website for registration to be valid.*
Other payments can be done via the method of your choice.
*Email us if finances are an issue - at Chabad no one is ever turned away due to lack of funds
Please Select Your Program

Session 3 - Jewish Numbers - $225 ($25 per class) Session 4 - Jewish Shapes - $135 ($25 per class) Package of 4 Stand Alone Classes - $100
Total Paying Today

$0.00

I would like to pay today: Full amount $100.00 minimum $

Payment

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MOMMY AND ME REGISTRATION