Summer Kids Program - Chabad of Lake Success

Parent's Full Name*

First Name Last Name

Best number to reach you at*

Area Code Phone Number

Address*

E-mail*

I would like to receive news and updates by email

How many children are you signing up*

123

Child 1

Child 1 Full Name*

First Name Last Name

Child 1 Age*

Children will be divided by age group

Did your child already sign up for Lake Success Chabad Hebrew School*

YesNo

Which program is Child 1 attending ($20 per event except the Birthday Shabbos Lunches which are free)

Which program is Child 1 attending*

Child 2

Child 2 Full Name*

First Name Last Name

Child 2 Age*

Children will be divided by age group

Did your child already sign up for Lake Success Chabad Hebrew School*

YesNo

Which program is Child 2 attending ($20 per event except the Birthday Shabbos Lunches which are free)*

Which program is Child 2 attending*

Child 3

Child 3 Full Name*

First Name Last Name

Child 3 Age*

Children will be divided by age group

Did your child already sign up for Lake Success Chabad Hebrew School*

YesNo

Which program is Child 3 attending ($20 per event except the Birthday Shabbos Lunches which are free)*

Which program is Child 3 attending*

Total

$0.00

Payment*

Credit Card Paypal

Postal / Zip Code

Country

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