Chessed Club Online Registration - Chabad of West Hempstead

REGISTER SCHEDULE

CHESSED CLUB 2026/2027 5787 REGISTRATION
CHILD INFORMATION
Child's Name*
First Name Last Name
Child's Birthday*

Month Day Year
Child's Age *
School*
Grade*
Please list any allergies that your child may have.
PARENT INFORMATION
Parent's Name (1)*
First Name Last Name
Parent's Home Phone (1)*

Area Code Phone Number
Parent's Cell Phone (1)*

Area Code Phone Number
Parent's Email Address (1)*
Parent's Name (2)
First Name Last Name
Parent's Cell Phone (2)

Area Code Phone Number
Comments/Questions:
*

Click to verify the full payment of $150.Check if you would like to sponsor another child for this club.
Total

$0.00

Payment

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Name on Card
Expiration Month	Expiration Year

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CHESSED CLUB 2026/2027 5787 REGISTRATION