Kids 'n Action - Sign Up

$125 - annual membership

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

 Child's First Name
 Child's Last Name
 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]