Register

STUDENT INFORMATION
We are currently accepting application forms for: Mommy 'n Me 2019-2020 and Kids in the Kitchen 2019-2020. Please fill out ALL fields of this form. If you have any questions or concerns, please contact us at 248-855-6170 or zeesy@baischabad.com.
Child's Full Name
First NameLast Name
Birth Date
MonthDayYear
Hebrew Name
Jewish Education Current/Previous
YesNo
If yes, where?
Siblings names and ages
Does your child have asthma, food allergies or any other medical condition?
YesNo
Is there any information concerning your child that is important for the directors of Bais Chabad Youth Zone to know?
Do you give permission to use photographs of your child in print materials, on our website and emails?
YesNo
PARENT INFORMATION
Parent's Name
First NameLast Name
Parent's E-mail
Phone Number
Area CodePhone Number
PAYMENT & REGISTRATION
My child will be attending:
The Great Hamentashen Bake: $15Mommy & Me Single Class: $12
Total
$0.00