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Registration

Registration

Chabad Jewish Center
Boise, Idaho

Mommy & Me Registration
2016-2017

Yes! I want to register my child.
Child's Name   Child's Jewish Name
Child's Age   Child's D.O.B.
Mother's Full Name   Mother's Religion
Father's Full Name   Father's Religion
Address   Apt.
City, State, Zip
City State Zip
  Home Phone
Mother's Cell Phone   Father's Cell Phone
Email   Facebook Name (for schedules & photos)
Is there any information concerning your child that is important for the directors of Mommy & Me to know?
(e.g.: asthma, food allergies, etc.)

Do you give permission to use photographs of your child in print materials, on our website, emails and
Facebook? Yes No

How did you hear about Mommy & Me at Chabad?
Payment

First Name
Last Name
Address
City
State
Zip Code
Phone
 
   
Card Number
Expiration Date
CVV Security Code What's This

AMOUNT:

  • $15 for one session
  • $270 for entire year
  • $135 first installment for entire year

Please charge my card: $ .00
I will send a check / pay cash.

I understand that by submitting this form I am committing to pay the above outlined fees.
Initials Date
 
 
 

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