Judaism through Art Program 2023/5

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1. REGISTRATION INFORMATION

* Family name

First name

* Primary Email Address

2. ATTENDEE INFORMATION

* Select Number of Children for one or each session

Single Class (1 class - $10)

Fall Session (4 classes - $50)

Winter Session (10 classes - $85)

Spring Session (6 classes $75)

If you selected single class please choose a date

Total Amount Due

3. STUDENTS INFORMATION

Child 1

* Name (First & Last):

* Gender

* Date of Birth:

Child 2

Name (First & Last):

Gender:

Date of Birth:

Child 3

Name (First & Last):

Gender:

Date of Birth:

Child 4

Name (First & Last):

Gender:

Date of Birth:

Child 5

Name (First & Last):

Gender:

Date of Birth:

Child 6

Name (First & Last):

Gender:

Date of Birth:

Child 7

Name (First & Last):

Gender:

Date of Birth:

Child 8

Name (First & Last):

Gender:

Date of Birth:

Child 9

Name (First & Last):

Gender:

Date of Birth:

Child 10

Name (First & Last):

Gender:

Date of Birth:

4. PARENTS INFORMATION

Father's Information

* Father's Information (First & Last Name)

Father's Phone Number:

Father's Email:

Adress

City

State

Zip code

Mother's Information (skip fields if same as Father)

Mother's Information (First & Last Name)

Mother's Phone Number:

Mother's Email:

Adress

City

State

Zip code

* I authorize the Chabad Israeli Center to take, use, and publish photographs, video or audio recordings, or quotations from interviews of my child which may be used for editorial, fundraising, and/or promotional and advertising purpose and in any manner and media.

Please Select OneAgreeNot agree

Total Amount Due

Tuition can be paid in installments. You may select up to 2 monthly or 8 weekly payments on the payment page. First installment is due upon registration. Tuition must be paid up by December 31st 2022. All payment plans will be automatically adjusted to end on December 31st. If you have a specific situation please contact the office at 4042529508 and we will gladly assist you.

Attention

click "SUBMIT" to send this form when you're done.

Thu, April 25 2024
17 Nisan 5784

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Thu, April 25 2024 17 Nisan 5784