Kids 'n Action - Sign Up

$125 - annual membership

 Father's First Name 
 Mother's First Name
 Address
 City
 Postal Code
 Phone
 Email Address

 Child's First Name
 Child's Last Name
 School 
 Grade
 Birthday (mm/dd/yyyy)

 Emergency Contact Number

I/We hereby authorize our child to participate in all Mini Chefs activities

Please charge my card in the  amount of:   $125  /   $  Other

Form of payment:

         
 Card Number
  Month      Year

I will mail my check payable to Chabad of the Tri-Valley to: 784 Palomino Drive - Pleasanton, CA 94566

 Please provide any additional comments here: 

 

Questions? Please call (925) 846-0700

 or email: [email protected]