Chessed Club Online Registration - ChabadWestHempstead.org

Chessed Club 2024 REGISTRATION
CHILD INFORMATION
Child's Name*

First Name Last Name
Child's Birthday*

Month Day Year
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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)*

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Parent's Email Address (1)*
Parent's Name (2)

First Name Last Name
Parent's Cell Phone (2)

Area Code Phone Number
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The cost to enroll in this program is $120. Please choose one of the following payment options:
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$120
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Chessed Club 2024 REGISTRATION