Chai 5

Address

E-mail
Phone Number
Area CodePhone Number
Child's Information
Child 1*
First NameLast Name
Birth Date*
MonthDayYear
School*
Grade*
Child 2
First NameLast Name
Birth Date
MonthDayYear
School
Grade
Important Info:
All important info. & updates will be sent through a What’s App Broadcast list In order to receive these messages, you need to have Hadassah Geisinskys contact in your phone. ¦ I have added Hadassah Geisinsky 516-458-3694 to my contacts
Payment
Cost: $180 per child | 10% discount for Chabad members
Amount
$180$162$360$324

Payment

Credit Card

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Street Address

Street Address Line 2

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Parent's Information