RSVP Form

Child's full name:                

 

Child's date of birth:           

 

Mother/Father's full name:

 

Address:                                

 

City/State/Zip:    

 

Phone number:                  

 

E-mail address:                  

 

Best way to reach me:      

 

Please note: Children under 3 years old must be accompanied by a parent throughout the program. 

 

$10 per session 

$75 for all 9 sessions

Family discount - Siblings pay half price!

First Session you come to is complimentary!

Payment / Donation Method

Purchase Amount:

Donation Amount:  

Checkout Total:  

  I will be making a donation by Check (Please make checks payable to Chabad of Merrick-Bellmore) 2083 Seneca Gate, Merrick, NY 11566

Please Charge My Card 

Charge my:
Credit Card Number:
Expiration Date:	01 02 03 04 05 06 07 08 09 10 11 12 2018 2019 2020 2021 2022 2023 2024 2025 2026
CVV Security Code:
Billing Zip Code:

 Thank You!