Registration Form - Chabad Jewish Center of NWBC
« Back to Chabad Jewish Center of NWBC

Registration Form

  • Child-Participant Information

  • Friendship Visit Selection

  • until
  • until
  • Parent's Information

  • Medical & Emergency Information

  • A. In case of an emergency when neither parent can be reached please provide the name of a person who will assume responsibility for your child.

  • B. If parents cannot be reached and emergency medical advice is required, permission is granted to the Friendship Circle staff to contact my child's physician.

  • C. Additional medical information or comments

  • Parental Agreement

  • Should be Empty:
Secure This page uses TLS encryption to keep your data secure.