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ckids_logo for webpage.jpg 

Chabad Kids Club Registration Form 

Family name *

         
 

Child #1 name * 
 

Child #1 birthdate *  
 

Child #1 grade *  
 
 

Child #2 name 
 

Child #2 birthdate   
 

Child #2 grade   
 
 

Child #3 name 
 

Child #3 birthdate   
 

Child #3 grade   
 
 

Child #4 name 
 

Child #4 birthdate   
 

Child #4 grade   
 
        


  

 

 

  Parents' Information:
 Names

 Father 
 

 Mother 
 
 Address  
 City, State  
 Zip  
 Phone numbers  Father's cell #
 		 Mother's cell #
  
 Email  Father's email
 		 Mother's email