Kids Club (Members) - Chabad Lubavitch of Greater Daytona

Please scroll down to register

Please note: Registration for the Shabbos program must be completed by the Thursday prior to the Shabbos you wish to attend. Registrations submitted after this deadline will not be accepted for that week.

If you are registering for only a single program, please select the individual program option.

General Information

Parent's Full Name*

Last Name First Name

E-mail*

I would like to receive news and updates by email

Phone Number*

Area Code Phone Number

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Child & Program Information

How many children are you registering for?*

Child #1 Name*

Last First

Child #1 Grade*

Child #1 Birth Date*

Month Day Year

Child #1 Programs Selected*

Individual Program ($9 per child)High Holidays + Shavuot ($25 per child)Full year Shabbos ($137.5 per child)

Child #1 Programs Selected*

Individual Program ($9 per child)High Holidays + Shavuot ($25 per child)Full year Shabbos ($150 per child)

Does child #1 have any allergies?*

Child #2 Name*

Last First

Child #2 Grade*

Child # 2 Birth Date*

Month Day Year

Child #2 Programs Selected*

Individual Program ($9 per child)High Holidays + Shavuot ($25 per child)Full year Shabbos ($137.50 per child)

Child #2 Programs Selected*

Individual Program ($9 per child)High Holidays + Shavuot ($25 per child)Full year Shabbos ($150 per child)

Does child #2 have any allergies?*

Child #3 Name*

Last First

Child #3 Grade*

Child #3 Birth Date*

Month Day Year

Child #3 Programs Selected*

Individual Program ($9 per child)High Holidays + Shavuot ($25 per child)Full year Shabbos ($137.50 per child)

Child #3 Programs Selected*

Individual Program ($9 per child)High Holidays + Shavuot ($25 per child)Full year Shabbos ($150 per child)

Does child #3 have any allergies?*

Child #4 Name*

Last First

Child #4 Grade*

Child #4 Birth Date*

Month Day Year

Child #4 Programs Selected*

Individual Program ($9 per child)High Holidays + Shavuot ($25 per child)Full year Shabbos ($137.50 per child)

Child #4 Programs Selected*

Individual Program ($9 per child)High Holidays + Shavuot ($25 per child)Full year Shabbos ($150 per child)

Does child #4 have any allergies?*

Please select Program date*

Month Day Year

Payment Information

Total

$0.00

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country