New Registration - Chabad of the South Hills - Jewish Center for Living & Learning

Child Profile
Name*
First NameLast NameJewish Name
Date of Birth*
MonthDayYear
What time of day was your child born? (to calculate Jewish Birthday)
DayAfter Nightfall
Grade Entering Fall 2022*
Any Allergies?*
Use this space for anything you would like us to know about your child!
Family Information
Parent 1 Info
First NameLast NameJewish Name
Phone Number
Area CodePhone Number
E-mail*
Parent 2 Info
First NameLast NameJewish Name
Phone Number
Area CodePhone Number
E-mail
Are there any adoptions or conversions in the family? If yes, please explain:

Address*

Emergency Contact Name*
First NameLast Name
Emergency Contact Phone Number*
Area CodePhone Number
I allow my child to be photographed while participating in Chabad activities and that these pictures may be used for marketing purposes.
$540/Child
$450/Child EARLY BIRD DISCOUNT BEFORE JUNE 30th
Please Select*
Pay in Full: $540Two Payments: $270 due todayI would like to discuss my payment plan
Total
$0.00

Payment

Credit Card Check, Cash

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Child Profile