Register - BaisChabad.com

STUDENT INFORMATION
Child's Full Name and Age:
Does your child have asthma, food allergies or any other medical condition?

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Please list your child's allergies:
PARENT INFORMATION
Parent's Name

First Name Last Name
Parent's E-mail
Phone Number

Area Code Phone Number
PAYMENT & REGISTRATION
Baby Loves Shabbat

One Class: $15 Session of Four: $50 One Class (Two Siblings): $20 Session of Four (Two Siblings): $100
Total

$0.00

Payment*

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

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STUDENT INFORMATION