Returning Student Registration - ChabadChaiCenter.com

Student Information:
Full Name*
First Name Last Name
Family Information:
Mother's Name: *
Mother's E-mail:*
Medical Release:*

I hereby give consent to the administration of the CHAI Family Academy to take whatever medical measures they deem necessary, at my expense, for my child in the event of a medical emergency.
Permission Slips:*

I grant permission for my child to be photographed in individual or group pictures which may be used by CHAI Family Academy for P.R.
Registration*

I would like to register my child for the 2023/2024 session $800
Please accept my payment of:*

$
Total

$0.00

Payment

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We accept Visa, MasterCard, American Express, Discover
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Name on Card
Expiration Month	Expiration Year

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