<!DOCTYPE HTML PUBLIC "-//W3C//DTD XHTML 1.0 Transitional//EN" "http://www.w3.org/TR/html4/loose.dtd">

<html xmlns="http://www.w3.org/1999/xhtml" >
<head id="Head1">
<meta http-equiv="X-UA-Compatible" content="IE=edge" />
<meta http-equiv="Content-Type" content="text/html; charset=utf-8" />
<meta http-equiv="Content-Language" content="en" />

<meta property="og:image" content="https://w2.chabad.org/media/images/156/eYVW1563448.jpg" itemprop="image" width="218" height="168" />
<meta property="og:image:width" content="218" />
<meta property="og:image:height" content="168" />
<meta name="keywords" content="Registration,Form" />
<meta name="title" content="Registration Form - Chabad Center for Jewish Life" />
<meta property="og:type" content="website" />
<meta name="scope-aids" content="440407-440415-1416127-1408405-6495296-6501436" />
<meta name="article-keywords" content="31782-2185-20429-29058-21464-31783-8495-29136-2170-2898-20962" />
<meta name="scope-aid" content="440407" />
<meta name="scope-aid" content="440415" />
<meta name="scope-aid" content="1416127" />
<meta name="scope-aid" content="1408405" />
<meta name="scope-aid" content="6495296" />
<meta name="scope-aid" content="6501436" />
<meta name="article-keyword" content="31782" />
<meta name="article-keyword" content="2185" />
<meta name="article-keyword" content="20429" />
<meta name="article-keyword" content="29058" />
<meta name="article-keyword" content="21464" />
<meta name="article-keyword" content="31783" />
<meta name="article-keyword" content="8495" />
<meta name="article-keyword" content="29136" />
<meta name="article-keyword" content="2170" />
<meta name="article-keyword" content="2898" />
<meta name="article-keyword" content="20962" />
<meta property="og:url" content="https://www.chabadjewishlife.org/templates/articlecco_cdo/aid/6501436/jewish/Registration-Form.htm" />
<meta property="twitter:card" content="summary_large_image" />
<meta property="twitter:site" content="@chabad" />
<meta property="og:title" content="Registration Form - Chabad Center for Jewish Life" /><link rel="canonical" href="https://www.chabadjewishlife.org/templates/articlecco_cdo/aid/6501436/jewish/Registration-Form.htm" />
<link rel="image_src" href="https://w2.chabad.org/media/images/156/eYVW1563448.jpg" />
<link rel="icon" type="image/png" href="https://www.chabadjewishlife.org/media/images/1074/zqfd10743822.png" />
<link rel="Stylesheet" href="/css/fonts/font-awesome/font-awesome-5.css?v=2D6ABDDB" id="kfont-awesome" type="text/css"/>
<link rel="Stylesheet" href="/css/DefaultGrid.css?v=A13D74E8" id="kgrid" type="text/css"/>
<link rel="Stylesheet" href="/css/Elements.css?v=3A4C63F4" id="k6" type="text/css"/>
<link rel="Stylesheet" href="/css/vendor/ds/tokens/sites.css?v=72A49647" id="ksites-ds-css" type="text/css"/>
<link rel="Stylesheet" href="/css/new/main.css?v=BB63DD50" id="k7" type="text/css"/>
<link rel="Stylesheet" href="https://w2.chabad.org/css/cco/minisites/global.css" id="k20962" type="text/css"/>
<link rel="Stylesheet" href="/css/old/global.css?v=43DDBA77" id="k2898" type="text/css"/>
<link rel="Stylesheet" href="https://w2.chabad.org/images/Shluchim/minisites/themes/ckids/css/styles.css?v=9/8/2026" id="k31782" type="text/css"/>
<link rel="Stylesheet" href="/css/cco/templates/forms/formCss2.css?v=AB6A2925" id="kFormCss" type="text/css"/>
<link rel="Stylesheet" href="/css/cco/templates/forms/themes/nova.css?v=87AD6957" id="kNova" type="text/css"/>
<link rel="Stylesheet" href="/css/bootstrap/grid.css?v=F4390F2B" id="kbootstrap4-grid" type="text/css"/>
<link rel="Stylesheet" href="/css/Library/reader-comments.css?v=8AB57D79" id="kCommentsStylesheet" type="text/css"/>
<link rel="Stylesheet" href="/css/inline/BookInfo.css?v=3D052243" id="kBookInfoCss" type="text/css"/>

<script>$q=[];$j=function(f){$q.push(f);}</script>
	
 
	
	<style type="text/css">
		body{margin:0;}
	</style>
	
	



<script>
	window.dataLayer = window.dataLayer || [];
	dataLayer.push({"event":"datalayer-initialized","page":{"numberOfComments":0,"publicationDate":"2024-07-08","primaryArticleId":6501436,"title":"","author":"","authorId":0,"contentLevel1":"My Site","contentLevel2":"Programs","contentLevel3":"Youth","contentLevel4":"The Albert & Temi Horowitz CKids Club","contentLevel5":"Registration Form","siteName":"Chabad Center for Jewish Life"},"time":{"upcomingHoliday":"Shemini Atzeret &amp; Simchat Torah","daysToUpcomingHoliday":383,"hebrewDate":"5787-07-24"}});
		dataLayer.push({ 'articleHierarchy': '-440407-440415-1416127-1408405-6495296-6501436-', 'keywords': '-k20962-k2898-k2170-k29136-k8495-k31783-k21464-k29058-k20429-k2185-k31782-', 'k': '-440407-440415-1416127-1408405-6495296-6501436--k20962-k2898-k2170-k29136-k8495-k31783-k21464-k29058-k20429-k2185-k31782-' });
	
</script>
<script>

(function(c,h,a,b,a,d){c[a]=c[a]||[];c[a].push({'gtm.start':
new Date().getTime(),event:'gtm.js'});var f=h.getElementsByTagName(b)[0],
j=h.createElement(b);j.async=true;
j.src='https://w6.chabad.org/mitzvah-tank.js';f.parentNode.insertBefore(j,f);
})(window,document,0,'script','dataLayer');</script>

	<!-- Start of StatCounter Code -->
	<script type="text/javascript">
	var sc_project = 2087246;var sc_partition = 2;var sc_invisible = 1;var sc_remove_link=1;var sc_security = "9cf82961";var sc_https = 1;
	</script>
	<script type="text/javascript" src="https://secure.statcounter.com/counter/counter_xhtml.js" defer async></script>
	<noscript><img src="//c3.statcounter.com/counter.php?sc_project=2087246&amp;java=0&amp;security=9cf82961&amp;invisible=1" border="0" /> </noscript>
	<!-- End of StatCounter Code -->


<style>
/*
body, body.cco_body{
background:#fff !important;
}*/

.cco_search_header {float:right}
.float_left img {display: none;}
</style>

<link href='https://fonts.googleapis.com/css?family=Open+Sans:300italic,400italic,600italic,700italic,400,300,600,700' rel='stylesheet' type='text/css'>

<!-- Facebook Pixel Code -->

<noscript><img height="1" width="1" style="display:none"
  src="https://www.facebook.com/tr?id=517338615297944&ev=PageView&noscript=1"
/></noscript>
<!-- End Facebook Pixel Code -->
 <!-- Global site tag (gtag.js) - Google Analytics -->




<script>
  !function(f,b,e,v,n,t,s)
  {if(f.fbq)return;n=f.fbq=function(){n.callMethod?
  n.callMethod.apply(n,arguments):n.queue.push(arguments)};
  if(!f._fbq)f._fbq=n;n.push=n;n.loaded=!0;n.version='2.0';
  n.queue=[];t=b.createElement(e);t.async=!0;
  t.src=v;s=b.getElementsByTagName(e)[0];
  s.parentNode.insertBefore(t,s)}(window, document,'script',
  'https://connect.facebook.net/en_US/fbevents.js');
  fbq('init', '517338615297944');
  fbq('track', 'PageView');
</script><script async src="https://www.googletagmanager.com/gtag/js?id=UA-106788209-2"></script><script>
  window.dataLayer = window.dataLayer || [];
  function gtag(){dataLayer.push(arguments);}
  gtag('js', new Date());

  gtag('config', 'UA-106788209-2');
</script><script language="javascript" type="text/javascript" src="https://w4.chabad.org/scripts/js/os/jquery-latest.min.js?v=20170328.5"></script><script language="javascript" type="text/javascript">
jQuery(document).ready(function ($) {
    function toggleFields(fieldsList, sourceElm, val, condition) {
        var elm = $(sourceElm);
        elm.change(function () {
            let elmValue = parseInt($(this).val());
            var found = condition == '>=' ? elmValue >= val : elmValue == val;

            if ($(this).is(':radio')) {
                found = $(this).is(':checked');
            }

            fieldsList.forEach(function (i, x, a) {
                found ? $(i).show() : $(i).hide();

                if (!found) {
                    $(i).find('select', 'input').not(':radio', ':checkbox').each(function () {
                        $(this).val('');
                    });
                }
            });
        });
        elm.change();
    }
  });   
 

/*Tzvi changes for dinner form
console.log("Hello")

document.querySelector(".form_submit_button").addEventListener("click", function(){
let inputs = document.querySelectorAll(".form-radio validate[required]")
let active = "";
inputs.forEach(function(input){
     if(input.checked){
         console.log(input.getAttribute("id"))
      }
})
})
*/
</script><title>
	Registration Form - Chabad Center for Jewish Life
</title></head>
<body class="lang_en dir_ltr cco_body form secure cco_templateless_page section_branch">
	
	
		<div width="100%" class="cco_templateless_template" style="z-index:100 !important;display:block !important;left:0px !important;top:0px !important;height:30px!important;width:100% !important;line-height:30px !important; position:relative !important; margin-bottom:0 !important; padding:0;text-indent: 25px;" align="Left"><a href="//www.ChabadJewishLife.org" style="display:block!important;font-size:14px !important;">&laquo; Back to&nbsp;Chabad Center for Jewish Life</a></div>
	
	<div class="cco_templatelates_content">
		
	<div class="co_content_container clearfix local_content" id="co_content_container">
		<div class="clearfix">
			<!-- BEGIN HEADER --><style type="text/css">

    @import url("https://w5.chabad.org/images/Shluchim/minisites/themes/ckids/css/styles.css");
</style>


<div id="chabad_body_page" class="font-sans">
<div id="chabad_main_content">
<div id="chabad_head">

<div class="items-center justify-between md:px-8 md:pb-4 md:flex bg-purple">

<div class="relative flex items-center px-4 py-3 text-white no-underline md:px-0 md:py-0">

<img src="https://chabadjewishlife.org/media/images/1284/IgFr12849148.png" alt="logo" class="object-contain w-12 h-12 mr-2 md:mr-3" />

<div class="text-lg">
<strong class="font-bold">
  </strong>
<span class="block"> 
  </span></div>

<a href="/6495296" class="absolute inset-0"></a>
</div>


<div class="chabad_navigator_bar">
<img src="https://w2.chabad.org/images/Shluchim/minisites/themes/ckids/YlIY12218480.png" id="img_nav" alt="" />

<div id="navigation" class="chabad_navigator_bar">
<div class="chabad_menu_content">
<ul id="menu" class="navi">
<li class="item parent arrow">
<a href="/article.asp?aid=6497331" class="parent arrow">About Us</a>
<div class="sub_menu">
<ul>
<li class="item first last">
<a href="/article.asp?aid=6538035">Frequently Asked Questions</a>
</li>
</ul>
</div>
|
</li>
<li class="item parent">
<a href="/article.asp?aid=7409103" class="parent">Calendar</a>
|
</li>
<li class="item parent">
<a href="/article.asp?aid=7427406" class="parent">Activity Calendar</a>
|
</li>
<li class="item parent">
<a href="/article.asp?aid=6518042" class="parent">Rates</a>
|
</li>
<li class="item parent selected">
<a href="/article.asp?aid=6501436" class="parent selected">Registration Form</a>
|
</li>
<li class="item parent">
<a href="/article.asp?aid=6518044" class="parent">Contact Us</a>
</li>

</ul>
</div>
</div>

</div>
</div>
</div>
<div id="chabad_body_content">
<div class="chabad_left_column">

<div detached="true" type="static" id="ContentArea" name="content_area" actions="edit" class="chabad_left_column"><div id="content_page" class="content_page"><!-- END HEADER -->
			
			
			<div class="clearfix bh mobile-only align_right">ב"ה</div>
			
				<div class="master-content-wrapper " >
					

<header class="article-header cf ">
	
	
			<h1 class="article-header__title js-article-title js-page-title">Registration Form</h1>
		
			<div>
				
			</div>
		
</header>
				</div>
			
			<div class="body_wrapper clearfix co_body">
				<div class="" id="co_body_container">
					
					<div id="ContentBody">
						
						
							<div class="content-area-parent no_margin">
								
	<div id="cco_body">
		<div class="content  no_margin no_overflow" id="co_content_container">
			
			
	

	<article class="content js-content" >
	

<div id="formContainer"><script type="text/javascript">var defaultCurrency = { value: 'USD', symbol: '$'};
$j(function(){
window.multiplier = 0;
window.formJson = Object.extend([{"form_height":736,"49_text":"The Albert \u0026amp; Temi Horowitz CKids Club","49_subHeader":"","49_headerType":"Default","49_name":"clickTo","49_qid":49,"49_type":"control_head","49_order":1,"40_text":"\u003cp style=\"text-align: center;\"\u003eWelcome! We are thrilled you are considering joining the Albert \u0026amp; Temi Horowitz CKids Club. Space is limited, and acceptance is prioritized for alumni of the Alan \u0026amp; Tatyana\u0026#160;Forman Jewish Early Learning Center and those affiliated with the Chabad Center. If accepted, you will receive the registration form. We look forward to the possibility of having your child(ren) with us!\u003c/p\u003e\n","40_name":"doubleclickTo40","40_qid":40,"40_type":"control_text","40_order":2,"7_text":"Number of children you would like to enroll:","7_message":"","7_labelAlign":"Auto","7_required":"Yes","7_size":5,"7_maxsize":"","7_minValue":"","7_maxValue":"3","7_defaultValue":"1","7_subLabel":"","7_hint":"ex: 2","7_description":"","7_readonly":"No","7_pricePerItem":25,"7_name":"number7","7_qid":7,"7_type":"control_number","7_order":3,"118_text":"Child\u0027s Information","118_subHeader":"","118_headerType":"Default","118_name":"clickTo118","118_qid":118,"118_type":"control_head","118_order":4,"97_text":"Is your child enrolled at Chabad Hebrew School for the 2026-2027 school year?","97_message":"","97_labelAlign":"Auto","97_required":"Yes","97_options":"Yes|No|My child is a JELC Pre-K Student","97_special":"None","97_allowOther":"No","97_otherText":"Other","97_calculateOther":"No","97_selected":"","97_spreadCols":"1","97_description":"","97_name":"input97","97_qid":97,"97_type":"control_radio","97_order":5,"35_text":"Child\u0027s Name:","35_message":"","35_labelAlign":"Auto","35_required":"Yes","35_prefix":"No","35_suffix":"No","35_middle":"No","35_description":"","35_sublabels":{"prefix":"Prefix","first":"First Name","middle":"Middle Name","last":"Last Name","suffix":"Suffix"},"35_readonly":"No","35_name":"fullName35","35_qid":35,"35_type":"control_fullname","35_order":6,"67_text":"Hebrew Name:","67_message":"","67_labelAlign":"Auto","67_required":"No","67_size":20,"67_validation":"None","67_maxsize":"","67_inputTextMask":"","67_defaultValue":"","67_subLabel":"","67_hint":" ","67_description":"","67_readonly":"No","67_name":"input67","67_qid":67,"67_type":"control_textbox","67_order":7,"37_text":"Child\u0027s Date of Birth:","37_message":"","37_labelAlign":"Auto","37_required":"Yes","37_format":"mmddyyyy","37_yearFrom":"","37_yearTo":"","37_months":[[],[],[],[],[],[],[],[],[],[],[],[]],"37_description":"","37_sublabels":{"month":"Month","day":"Day","year":"Year"},"37_name":"birthDate","37_qid":37,"37_type":"control_birthdate","37_order":8,"119_text":"Gender","119_message":"","119_labelAlign":"Auto","119_required":"Yes","119_options":"Male|Female","119_special":"None","119_allowOther":"No","119_otherText":"Other","119_calculateOther":"No","119_selected":"","119_spreadCols":"1","119_description":"","119_name":"input119","119_qid":119,"119_type":"control_radio","119_order":9,"42_text":"Child\u0027s Age:","42_message":"","42_labelAlign":"Auto","42_required":"Yes","42_size":5,"42_maxsize":"","42_minValue":"","42_maxValue":"","42_defaultValue":"","42_subLabel":"","42_hint":" ","42_description":"","42_readonly":"No","42_pricePerItem":0,"42_name":"number42","42_qid":42,"42_type":"control_number","42_order":10,"114_text":"Current grade at school","114_message":"","114_labelAlign":"Auto","114_required":"Yes","114_options":"PreK|Kindergarten|1st Grade|2nd Grade|3rd Grade|4th Grade|5th Grade|6th Grade|7th Grade","114_special":"None","114_size":0,"114_width":150,"114_selected":"","114_subLabel":"","114_description":"","114_emptyText":"","114_name":"input114","114_qid":114,"114_type":"control_dropdown","114_order":11,"62_text":"School:","62_message":"","62_labelAlign":"Auto","62_required":"No","62_size":20,"62_validation":"None","62_maxsize":"","62_inputTextMask":"","62_defaultValue":"","62_subLabel":"","62_hint":" ","62_description":"","62_readonly":"No","62_name":"input62","62_qid":62,"62_type":"control_textbox","62_order":12,"56_text":"School District","56_message":"","56_labelAlign":"Auto","56_required":"No","56_size":20,"56_validation":"None","56_maxsize":"","56_inputTextMask":"","56_defaultValue":"","56_subLabel":"","56_hint":" ","56_description":"","56_readonly":"No","56_name":"input56","56_qid":56,"56_type":"control_textbox","56_order":13,"74_text":"Any allergies?","74_message":"","74_labelAlign":"Auto","74_required":"No","74_size":20,"74_validation":"None","74_maxsize":"","74_inputTextMask":"","74_defaultValue":"","74_subLabel":"","74_hint":" ","74_description":"","74_readonly":"No","74_name":"input74","74_qid":74,"74_type":"control_textbox","74_order":14,"77_text":"Monday 5:30 - 6:30 pm session","77_message":"","77_labelAlign":"Auto","77_required":"No","77_options":"STEM/Science: 10/5 - 11/23 ($63 for 7 week session)|Sports and movements: 4/19 - 6/7 ($54 for 6 week session)|Drama: 11/30-04/12 ($126 for 14 week session)","77_special":"None","77_allowOther":"No","77_otherText":"Other","77_calculateOther":"No","77_spreadCols":"1","77_selected":"","77_minSelection":"","77_maxSelection":"","77_description":"","77_name":"input77","77_qid":77,"77_type":"control_checkbox","77_order":15,"77_pricing":"63|126|54","78_text":"Thursday 5:30 - 6:30 pm session","78_message":"","78_labelAlign":"Auto","78_required":"No","78_options":"Baking: 10/8 - 11/19 ($63 for 7 week session)|Hebrew Language: 12/3 - 1/28 ($63 for 7 week session)|Art: 2/4 - 4/8 ($63 for  7 week session)|Gymnastic: 4/15 - 6/3 ($54 for 6 week session)","78_special":"None","78_allowOther":"No","78_otherText":"Other","78_calculateOther":"No","78_spreadCols":"1","78_selected":"","78_minSelection":"","78_maxSelection":"","78_description":"","78_name":"input78","78_qid":78,"78_type":"control_checkbox","78_order":16,"78_pricing":"63|63|63|54","137_text":"Monday 5:30 - 6:30 pm session","137_message":"","137_labelAlign":"Auto","137_required":"No","137_options":"STEM/Science: 10/5 - 11/23 ($95 for 7 week session)|Sports and movements: 4/19 - 6/7 ($81 for 6 week session)|Drama: 11/30-04/12 ($190 for 14 week session)","137_special":"None","137_allowOther":"No","137_otherText":"Other","137_calculateOther":"No","137_spreadCols":"1","137_selected":"","137_minSelection":"","137_maxSelection":"","137_description":"","137_name":"input137","137_qid":137,"137_type":"control_checkbox","137_order":17,"137_pricing":"95|81|190","138_text":"Thursday 5:30 - 6:30 pm session","138_message":"","138_labelAlign":"Auto","138_required":"No","138_options":"Baking: 10/8 - 11/19 ($95 for 7 week session)|Hebrew Language: 12/3 - 1/28 ($95 for 7 week session)|Art: 2/4 - 4/8 ($95 for  7 week session)|Gymnastic: 4/15 - 6/3 ($81 for 6 week session)","138_special":"None","138_allowOther":"No","138_otherText":"Other","138_calculateOther":"No","138_spreadCols":"1","138_selected":"","138_minSelection":"","138_maxSelection":"","138_description":"","138_name":"input138","138_qid":138,"138_type":"control_checkbox","138_order":18,"138_pricing":"95|95|95|81","102_text":"Monday 5:30 - 6:30 pm session","102_message":"","102_labelAlign":"Auto","102_required":"No","102_options":"STEM/Science: 10/5 - 11/23 ($126 for 7 week session)|Drama: 11/30 - 4/12 ($252 for 14 week session)|Sports and movements: 4/19 - 6/7 ($108 for 6 week session)","102_special":"None","102_allowOther":"No","102_otherText":"Other","102_calculateOther":"No","102_spreadCols":"1","102_selected":"","102_minSelection":"","102_maxSelection":"","102_description":"","102_name":"input102","102_qid":102,"102_type":"control_checkbox","102_order":19,"102_pricing":"126|252|108","104_text":"Thursday 5:30 - 6:30 pm session","104_message":"","104_labelAlign":"Auto","104_required":"No","104_options":"Baking: 10/8 - 11/19 ($126 for 7 week session)|Hebrew Language: 12/3 - 1/28 ($126 for 7 week session)|Art: 2/4 - 4/8 ($126 for  7 week session)|Gymanstic: 4/15 - 6/3 ($108 for 6 week session)","104_special":"None","104_allowOther":"No","104_otherText":"Other","104_calculateOther":"No","104_spreadCols":"1","104_selected":"","104_minSelection":"","104_maxSelection":"","104_description":"","104_name":"input104","104_qid":104,"104_type":"control_checkbox","104_order":20,"104_pricing":"126|126|126|108","88_text":"Additional learning opportunities","88_message":"","88_labelAlign":"Auto","88_required":"No","88_options":"Jewish Learning|Hebrew Reading","88_special":"None","88_allowOther":"No","88_otherText":"Other","88_calculateOther":"No","88_spreadCols":"1","88_selected":"","88_minSelection":"","88_maxSelection":"","88_description":"","88_name":"input88","88_qid":88,"88_type":"control_checkbox","88_order":21,"122_text":"Child 2 Information","122_subHeader":"","122_headerType":"Default","122_name":"clickTo122","122_qid":122,"122_type":"control_head","122_order":22,"98_text":"Is your child enrolled at Chabad Hebrew School for the 2026-2027 school year?","98_message":"","98_labelAlign":"Auto","98_required":"Yes","98_options":"Yes|No|My child is a JELC Pre-K Student","98_special":"None","98_allowOther":"No","98_otherText":"Other","98_calculateOther":"No","98_selected":"","98_spreadCols":"1","98_description":"","98_name":"input98","98_qid":98,"98_type":"control_radio","98_order":23,"44_text":"Child 2 Name:","44_message":"","44_labelAlign":"Auto","44_required":"Yes","44_prefix":"No","44_suffix":"No","44_middle":"No","44_description":"","44_sublabels":{"prefix":"Prefix","first":"First Name","middle":"Middle Name","last":"Last Name","suffix":"Suffix"},"44_readonly":"No","44_name":"fullName44","44_qid":44,"44_type":"control_fullname","44_order":24,"68_text":"Child 2 Hebrew Name:","68_message":"","68_labelAlign":"Auto","68_required":"Yes","68_size":20,"68_validation":"None","68_maxsize":"","68_inputTextMask":"","68_defaultValue":"","68_subLabel":"","68_hint":" ","68_description":"","68_readonly":"No","68_name":"input68","68_qid":68,"68_type":"control_textbox","68_order":25,"43_text":"Child 2: Date of Birth","43_message":"","43_labelAlign":"Auto","43_required":"Yes","43_format":"mmddyyyy","43_yearFrom":"","43_yearTo":"","43_months":[[],[],[],[],[],[],[],[],[],[],[],[]],"43_description":"","43_sublabels":{"month":"Month","day":"Day","year":"Year"},"43_name":"birthDate43","43_qid":43,"43_type":"control_birthdate","43_order":26,"120_text":"Child 2: Gender","120_message":"","120_labelAlign":"Auto","120_required":"Yes","120_options":"Male|Female","120_special":"None","120_allowOther":"No","120_otherText":"Other","120_calculateOther":"No","120_selected":"","120_spreadCols":"1","120_description":"","120_name":"input120","120_qid":120,"120_type":"control_radio","120_order":27,"38_text":"Child 2: Age","38_message":"","38_labelAlign":"Auto","38_required":"Yes","38_size":5,"38_maxsize":"","38_minValue":"","38_maxValue":"","38_defaultValue":"","38_subLabel":"","38_hint":" ","38_description":"","38_readonly":"No","38_pricePerItem":0,"38_name":"number","38_qid":38,"38_type":"control_number","38_order":28,"115_text":"Child 2: Current grade at school","115_message":"","115_labelAlign":"Auto","115_required":"No","115_options":"PreK|Kindergarten|1st Grade|2nd Grade|3rd Grade|4th Grade|5th Grade|6th Grade|7th Grade","115_special":"None","115_size":0,"115_width":150,"115_selected":"","115_subLabel":"","115_description":"","115_emptyText":"","115_name":"input115","115_qid":115,"115_type":"control_dropdown","115_order":29,"64_text":"Child 2: School","64_message":"","64_labelAlign":"Auto","64_required":"No","64_size":20,"64_validation":"None","64_maxsize":"","64_inputTextMask":"","64_defaultValue":"","64_subLabel":"","64_hint":" ","64_description":"","64_readonly":"No","64_name":"input64","64_qid":64,"64_type":"control_textbox","64_order":30,"60_text":"Child 2: School District","60_message":"","60_labelAlign":"Auto","60_required":"No","60_size":20,"60_validation":"None","60_maxsize":"","60_inputTextMask":"","60_defaultValue":"","60_subLabel":"","60_hint":" ","60_description":"","60_readonly":"No","60_name":"input60","60_qid":60,"60_type":"control_textbox","60_order":31,"75_text":"Any allergies?","75_message":"","75_labelAlign":"Auto","75_required":"No","75_size":20,"75_validation":"None","75_maxsize":"","75_inputTextMask":"","75_defaultValue":"","75_subLabel":"","75_hint":" ","75_description":"","75_readonly":"No","75_name":"input75","75_qid":75,"75_type":"control_textbox","75_order":32,"79_text":"Monday 5:30 - 6:30 pm session","79_message":"","79_labelAlign":"Auto","79_required":"No","79_options":"STEM/Science: 10/5-11/23 ($63 for 7 week session)|Drama: 11/30-04/12 ($126 for 14 week session)|Sports and movements: 04/19- 06/7 ($54 for 6 week session)","79_special":"None","79_allowOther":"No","79_otherText":"Other","79_calculateOther":"No","79_spreadCols":"1","79_selected":"","79_minSelection":"","79_maxSelection":"","79_description":"","79_name":"input79","79_qid":79,"79_type":"control_checkbox","79_order":33,"79_pricing":"63|126|54","80_text":"Thursday 5:30 - 6:30 pm session","80_message":"","80_labelAlign":"Auto","80_required":"No","80_options":"Baking: 10/8-11/19 ($63 for 7 week session)|Hebrew Language: 12/3-01/28 ($63 for 7 week session)|Art: 02/4-04/8 ($63 for  7 week session)|Gymnastic: 04/15-06/3 ($54 for 6 week session)","80_special":"None","80_allowOther":"No","80_otherText":"Other","80_calculateOther":"No","80_spreadCols":"1","80_selected":"","80_minSelection":"","80_maxSelection":"","80_description":"","80_name":"input80","80_qid":80,"80_type":"control_checkbox","80_order":34,"80_pricing":"63|63|63|54","139_text":"Monday 5:30 - 6:30 pm session","139_message":"","139_labelAlign":"Auto","139_required":"No","139_options":"STEM/Science: 10/5-11/23 ($95 for 7 week session)|Drama: 11/30-04/12 ($190 for 14 week session)|Sports and movements: 04/19- 06/7 ($81 for 6 week session)","139_special":"None","139_allowOther":"No","139_otherText":"Other","139_calculateOther":"No","139_spreadCols":"1","139_selected":"","139_minSelection":"","139_maxSelection":"","139_description":"","139_name":"input139","139_qid":139,"139_type":"control_checkbox","139_order":35,"139_pricing":"95|190|81","140_text":"Thursday 5:30 - 6:30 pm session","140_message":"","140_labelAlign":"Auto","140_required":"No","140_options":"Baking: 10/8-11/19 ($95 for 7 week session)|Hebrew Language: 12/3-01/28 ($95 for 7 week session)|Art: 02/4-04/8 ($95 for  7 week session)|Gymnastic: 04/15-06/3 ($95 for 7 week session)","140_special":"None","140_allowOther":"No","140_otherText":"Other","140_calculateOther":"No","140_spreadCols":"1","140_selected":"","140_minSelection":"","140_maxSelection":"","140_description":"","140_name":"input140","140_qid":140,"140_type":"control_checkbox","140_order":36,"140_pricing":"95|95|95|95","106_text":"Monday 5:30 - 6:30 pm session","106_message":"","106_labelAlign":"Auto","106_required":"No","106_options":"STEM/Science: 10/5-11/23 ($126 for 7 week session)|Drama: 11/30-04/12 ($252 for 14 week session)|Sports and movements: 04/19- 06/7 ($108 for 6 week session)","106_special":"None","106_allowOther":"No","106_otherText":"Other","106_calculateOther":"No","106_spreadCols":"1","106_selected":"","106_minSelection":"","106_maxSelection":"","106_description":"","106_name":"input106","106_qid":106,"106_type":"control_checkbox","106_order":37,"106_pricing":"126|252|108","108_text":"Thursday 5:30 - 6:30 pm session","108_message":"","108_labelAlign":"Auto","108_required":"No","108_options":"Baking: 10/8-11/19 ($126 for 7 week session)|Hebrew Language: 12/3-01/28 ($126 for 7 week session)|Art: 02/4-04/8 ($126 for  7 week session)|Gymnastic: 04/15-06/3 ($108 for 6 week session)","108_special":"None","108_allowOther":"No","108_otherText":"Other","108_calculateOther":"No","108_spreadCols":"1","108_selected":"","108_minSelection":"","108_maxSelection":"","108_description":"","108_name":"input108","108_qid":108,"108_type":"control_checkbox","108_order":38,"108_pricing":"126|126|126|108","89_text":"Additional learning opportunities","89_message":"","89_labelAlign":"Auto","89_required":"No","89_options":"Jewish Learning|Hebrew Reading","89_special":"None","89_allowOther":"No","89_otherText":"Other","89_calculateOther":"No","89_spreadCols":"1","89_selected":"","89_minSelection":"","89_maxSelection":"","89_description":"","89_name":"input89","89_qid":89,"89_type":"control_checkbox","89_order":39,"123_text":"Child 3 Information","123_subHeader":"","123_headerType":"Default","123_name":"clickTo123","123_qid":123,"123_type":"control_head","123_order":40,"99_text":"Is your child enrolled at Chabad Hebrew School for the 2026-2027 school year?","99_message":"","99_labelAlign":"Auto","99_required":"Yes","99_options":"Yes|No|My child is a JELC Pre-K Student","99_special":"None","99_allowOther":"No","99_otherText":"Other","99_calculateOther":"No","99_selected":"","99_spreadCols":"1","99_description":"","99_name":"input99","99_qid":99,"99_type":"control_radio","99_order":41,"48_text":"Child 3 Name:","48_message":"","48_labelAlign":"Auto","48_required":"Yes","48_prefix":"No","48_suffix":"No","48_middle":"No","48_description":"","48_sublabels":{"prefix":"Prefix","first":"First Name","middle":"Middle Name","last":"Last Name","suffix":"Suffix"},"48_readonly":"No","48_name":"fullName48","48_qid":48,"48_type":"control_fullname","48_order":42,"69_text":"Child 3 Hebrew Name","69_message":"","69_labelAlign":"Auto","69_required":"Yes","69_size":20,"69_validation":"None","69_maxsize":"","69_inputTextMask":"","69_defaultValue":"","69_subLabel":"","69_hint":" ","69_description":"","69_readonly":"No","69_name":"input69","69_qid":69,"69_type":"control_textbox","69_order":43,"47_text":"Child 3 Date of Birth:","47_message":"","47_labelAlign":"Auto","47_required":"Yes","47_format":"mmddyyyy","47_yearFrom":"","47_yearTo":"","47_months":[[],[],[],[],[],[],[],[],[],[],[],[]],"47_description":"","47_sublabels":{"month":"Month","day":"Day","year":"Year"},"47_name":"birthDate47","47_qid":47,"47_type":"control_birthdate","47_order":44,"121_text":"Child 3: Gender","121_message":"","121_labelAlign":"Auto","121_required":"Yes","121_options":"Male|Female","121_special":"None","121_allowOther":"No","121_otherText":"Other","121_calculateOther":"No","121_selected":"","121_spreadCols":"1","121_description":"","121_name":"input121","121_qid":121,"121_type":"control_radio","121_order":45,"46_text":"Child 3 Age","46_message":"","46_labelAlign":"Auto","46_required":"Yes","46_size":5,"46_maxsize":"","46_minValue":"","46_maxValue":"","46_defaultValue":"","46_subLabel":"","46_hint":" ","46_description":"","46_readonly":"No","46_pricePerItem":0,"46_name":"number46","46_qid":46,"46_type":"control_number","46_order":46,"116_text":"Child 3: Current grade at school","116_message":"","116_labelAlign":"Auto","116_required":"No","116_options":"PreK|Kindergarten|1st Grade|2nd Grade|3rd Grade|4th Grade|5th Grade|6th Grade|7th Grade","116_special":"None","116_size":0,"116_width":150,"116_selected":"","116_subLabel":"","116_description":"","116_emptyText":"","116_name":"input116","116_qid":116,"116_type":"control_dropdown","116_order":47,"66_text":"Child 3: School","66_message":"","66_labelAlign":"Auto","66_required":"No","66_size":20,"66_validation":"None","66_maxsize":"","66_inputTextMask":"","66_defaultValue":"","66_subLabel":"","66_hint":" ","66_description":"","66_readonly":"No","66_name":"input66","66_qid":66,"66_type":"control_textbox","66_order":48,"58_text":"Child 3: School District","58_message":"","58_labelAlign":"Auto","58_required":"No","58_size":20,"58_validation":"None","58_maxsize":"","58_inputTextMask":"","58_defaultValue":"","58_subLabel":"","58_hint":" ","58_description":"","58_readonly":"No","58_name":"input58","58_qid":58,"58_type":"control_textbox","58_order":49,"76_text":"Any allergies?","76_message":"","76_labelAlign":"Auto","76_required":"No","76_size":20,"76_validation":"None","76_maxsize":"","76_inputTextMask":"","76_defaultValue":"","76_subLabel":"","76_hint":" ","76_description":"","76_readonly":"No","76_name":"input76","76_qid":76,"76_type":"control_textbox","76_order":50,"81_text":"Monday 5:30 - 6:30 pm session","81_message":"","81_labelAlign":"Auto","81_required":"No","81_options":"STEM/Science: 10/5-11/23 ($63 for 7 week session)|Drama: 11/30-04/12 ($126 for 14 week session)|Sports and movements: 04/19- 06/7 ($54 for 6 week session)","81_special":"None","81_allowOther":"No","81_otherText":"Other","81_calculateOther":"No","81_spreadCols":"1","81_selected":"","81_minSelection":"","81_maxSelection":"","81_description":"","81_name":"input81","81_qid":81,"81_type":"control_checkbox","81_order":51,"81_pricing":"63|126|54","82_text":"Thursday 5:30 - 6:30 pm session","82_message":"","82_labelAlign":"Auto","82_required":"No","82_options":"Baking: 10/8-11/19 ($63 for 7 week session)|Hebrew Language: 12/3-01/28 ($63 for 7 week session)|Art: 02/4-04/8 ($63 for  7 week session)|Gymnastic: 04/15-06/3 ($54 for 6 week session)","82_special":"None","82_allowOther":"No","82_otherText":"Other","82_calculateOther":"No","82_spreadCols":"1","82_selected":"","82_minSelection":"","82_maxSelection":"","82_description":"","82_name":"input82","82_qid":82,"82_type":"control_checkbox","82_order":52,"82_pricing":"63|63|63|54","141_text":"Monday 5:30 - 6:30 pm session","141_message":"","141_labelAlign":"Auto","141_required":"No","141_options":"STEM/Science: 10/5-11/23 ($95 for 7 week session)|Drama: 11/30-04/12 ($190 for 14 week session)|Sports and movements: 04/19- 06/7 ($81 for 6 week session)","141_special":"None","141_allowOther":"No","141_otherText":"Other","141_calculateOther":"No","141_spreadCols":"1","141_selected":"","141_minSelection":"","141_maxSelection":"","141_description":"","141_name":"input141","141_qid":141,"141_type":"control_checkbox","141_order":53,"141_pricing":"95|190|81","142_text":"Thursday 5:30 - 6:30 pm session","142_message":"","142_labelAlign":"Auto","142_required":"No","142_options":"Baking: 10/8-11/19 ($95 for 7 week session)|Hebrew Language: 12/3-01/28 ($95 for 7 week session)|Art: 02/4-04/8 ($95 for  7 week session)|Gymnastic: 04/15-06/3 ($81 for 6 week session)","142_special":"None","142_allowOther":"No","142_otherText":"Other","142_calculateOther":"No","142_spreadCols":"1","142_selected":"","142_minSelection":"","142_maxSelection":"","142_description":"","142_name":"input142","142_qid":142,"142_type":"control_checkbox","142_order":54,"142_pricing":"95|95|95|81","110_text":"Monday 5:30 - 6:30 pm session","110_message":"","110_labelAlign":"Auto","110_required":"No","110_options":"STEM/Science: 10/5-11/23 ($126 for 7 week session)|Drama: 11/30-04/12 ($252 for 14 week session)|Sports and movements: 04/19- 06/7 ($108 for 6 week session)","110_special":"None","110_allowOther":"No","110_otherText":"Other","110_calculateOther":"No","110_spreadCols":"1","110_selected":"","110_minSelection":"","110_maxSelection":"","110_description":"","110_name":"input110","110_qid":110,"110_type":"control_checkbox","110_order":55,"110_pricing":"126|252|108","112_text":"Thursday 5:30 - 6:30 pm session","112_message":"","112_labelAlign":"Auto","112_required":"No","112_options":"Baking: 10/8-11/19 ($126 for 7 week session)|Hebrew Language: 12/3-01/28 ($126 for 7 week session)|Art: 02/4-04/8 ($126 for  7 week session)|Gymnastic: 04/15-06/3 ($108 for 6 week session)","112_special":"None","112_allowOther":"No","112_otherText":"Other","112_calculateOther":"No","112_spreadCols":"1","112_selected":"","112_minSelection":"","112_maxSelection":"","112_description":"","112_name":"input112","112_qid":112,"112_type":"control_checkbox","112_order":56,"112_pricing":"126|126|126|108","90_text":"Additional learning opportunities","90_message":"","90_labelAlign":"Auto","90_required":"No","90_options":"Jewish Learning|Hebrew Reading","90_special":"None","90_allowOther":"No","90_otherText":"Other","90_calculateOther":"No","90_spreadCols":"1","90_selected":"","90_minSelection":"","90_maxSelection":"","90_description":"","90_name":"input90","90_qid":90,"90_type":"control_checkbox","90_order":57,"117_text":"Parent\u0027s Information","117_subHeader":"","117_headerType":"Default","117_name":"clickTo117","117_qid":117,"117_type":"control_head","117_order":58,"1_text":"Mother\u0027s Name:","1_message":"","1_labelAlign":"Auto","1_required":"Yes","1_prefix":"No","1_suffix":"No","1_middle":"No","1_description":"","1_sublabels":{"prefix":"Prefix","first":"First Name","middle":"Middle Name","last":"Last Name","suffix":"Suffix"},"1_readonly":"No","1_name":"fullName","1_qid":1,"1_type":"control_fullname","1_order":59,"5_text":"Mother\u0027s Cell Phone Number:","5_message":"","5_labelAlign":"Auto","5_required":"Yes","5_validation":"Numeric","5_countryCode":"No","5_inputMask":"disable","5_inputMaskValue":"(###) ###-####","5_description":"","5_sublabels":{"country":"Country Code","area":"Area Code","phone":"Phone Number","full":"Phone Number"},"5_readonly":"No","5_name":"phoneNumber","5_qid":5,"5_type":"control_phone","5_order":60,"3_receivesReceipts":"No","3_text":"Mother\u0027s E-mail:","3_message":"","3_labelAlign":"Auto","3_required":"Yes","3_size":30,"3_validation":"Email","3_maxsize":"","3_defaultValue":"","3_subLabel":"","3_hint":"ex: myname@example.com","3_description":"","3_confirmation":"No","3_confirmationHint":"Confirm Email","3_readonly":"No","3_name":"email","3_qid":3,"3_type":"control_email","3_order":61,"31_text":"Father\u0027s Name:","31_message":"","31_labelAlign":"Auto","31_required":"No","31_prefix":"No","31_suffix":"No","31_middle":"No","31_description":"","31_sublabels":{"prefix":"Prefix","first":"First Name","middle":"Middle Name","last":"Last Name","suffix":"Suffix"},"31_readonly":"No","31_name":"fullName31","31_qid":31,"31_type":"control_fullname","31_order":62,"32_text":"Father\u0027s Cell Phone Number:","32_message":"","32_labelAlign":"Auto","32_required":"No","32_validation":"None","32_countryCode":"No","32_inputMask":"enable","32_inputMaskValue":"(###) ###-####","32_description":"","32_sublabels":{"country":"Country Code","area":"Area Code","phone":"Phone Number","full":"Phone Number"},"32_readonly":"No","32_name":"phoneNumber32","32_qid":32,"32_type":"control_phone","32_order":63,"33_receivesReceipts":"No","33_text":"Father\u0027s E-mail:","33_message":"","33_labelAlign":"Auto","33_required":"No","33_size":30,"33_validation":"Email","33_maxsize":"","33_defaultValue":"","33_subLabel":"","33_hint":"ex: myname@example.com","33_description":"","33_confirmation":"No","33_confirmationHint":"Confirm Email","33_readonly":"No","33_name":"email33","33_qid":33,"33_type":"control_email","33_order":64,"34_text":"Address:","34_message":"","34_labelAlign":"Auto","34_required":"Yes","34_selectedCountry":"","34_description":"","34_subfields":"st1|st2|city|state|zip|country","34_sublabels":{"cc_firstName":"First Name","cc_lastName":"Last Name","cc_number":"Credit Card Number","cc_ccv":"Security Code","cc_exp_month":"Expiration Month","cc_exp_year":"Expiration Year","addr_line1":"Street Address","addr_line2":"Street Address Line 2","city":"City","state":"State / Province","postal":"Postal / Zip Code","country":"Country"},"34_name":"address","34_qid":34,"34_type":"control_address","34_order":65,"53_text":"Are both parents Jewish?","53_message":"","53_labelAlign":"Auto","53_required":"Yes","53_options":"Yes|No","53_special":"None","53_allowOther":"No","53_otherText":"Other","53_calculateOther":"No","53_selected":"","53_spreadCols":"1","53_description":"","53_name":"input53","53_qid":53,"53_type":"control_radio","53_order":66,"53_hidden":"No","87_text":"If no, which parent is Jewish?","87_message":"","87_labelAlign":"Auto","87_required":"No","87_options":"Mother|Father","87_special":"None","87_allowOther":"No","87_otherText":"Other","87_calculateOther":"No","87_selected":"","87_spreadCols":"1","87_description":"","87_name":"input87","87_qid":87,"87_type":"control_radio","87_order":67,"85_text":"Have there been any conversions/adoptions in the family history?","85_message":"","85_labelAlign":"Auto","85_required":"No","85_options":"Yes|No","85_special":"None","85_allowOther":"No","85_otherText":"Other","85_calculateOther":"No","85_selected":"","85_spreadCols":"1","85_description":"","85_name":"input85","85_qid":85,"85_type":"control_radio","85_order":68,"86_text":"If yes, please specify:","86_message":"","86_labelAlign":"Auto","86_required":"No","86_size":20,"86_validation":"None","86_maxsize":"","86_inputTextMask":"","86_defaultValue":"","86_subLabel":"","86_hint":" ","86_description":"","86_readonly":"No","86_name":"input86","86_qid":86,"86_type":"control_textbox","86_order":69,"72_text":"Would you be interested in learning more about our holiday programs and Hebrew School?","72_message":"","72_labelAlign":"Auto","72_required":"Yes","72_options":"Yes|No","72_special":"None","72_allowOther":"No","72_otherText":"Other","72_calculateOther":"No","72_selected":"","72_spreadCols":"1","72_description":"","72_name":"input72","72_qid":72,"72_type":"control_radio","72_order":70,"124_text":"Emergency Contact","124_subHeader":"","124_headerType":"Default","124_name":"clickTo124","124_qid":124,"124_type":"control_head","124_order":71,"125_text":"Emergency Contact 1","125_message":"","125_labelAlign":"Auto","125_required":"No","125_size":"50","125_validation":"None","125_maxsize":"","125_inputTextMask":"","125_defaultValue":"","125_subLabel":"","125_hint":" ","125_description":"","125_readonly":"No","125_name":"input125","125_qid":125,"125_type":"control_textbox","125_order":72,"126_text":"Emergency Contact 1 Phone","126_message":"","126_labelAlign":"Auto","126_required":"No","126_size":"50","126_validation":"None","126_maxsize":"","126_inputTextMask":"","126_defaultValue":"","126_subLabel":"","126_hint":" ","126_description":"","126_readonly":"No","126_name":"input126","126_qid":126,"126_type":"control_textbox","126_order":73,"127_text":"Emergency Contact 2","127_message":"","127_labelAlign":"Auto","127_required":"No","127_size":"50","127_validation":"None","127_maxsize":"","127_inputTextMask":"","127_defaultValue":"","127_subLabel":"","127_hint":" ","127_description":"","127_readonly":"No","127_name":"input127","127_qid":127,"127_type":"control_textbox","127_order":74,"128_text":"Emergency Contact 2 Phone","128_message":"","128_labelAlign":"Auto","128_required":"No","128_size":"50","128_validation":"None","128_maxsize":"","128_inputTextMask":"","128_defaultValue":"","128_subLabel":"","128_hint":" ","128_description":"","128_readonly":"No","128_name":"input128","128_qid":128,"128_type":"control_textbox","128_order":75,"129_text":"Doctor\u0027s Full Name","129_message":"","129_labelAlign":"Auto","129_required":"No","129_size":"50","129_validation":"None","129_maxsize":"","129_inputTextMask":"","129_defaultValue":"","129_subLabel":"","129_hint":" ","129_description":"","129_readonly":"No","129_name":"input129","129_qid":129,"129_type":"control_textbox","129_order":76,"130_text":"Doctor\u0027s Phone Number","130_message":"","130_labelAlign":"Auto","130_required":"No","130_size":"50","130_validation":"None","130_maxsize":"","130_inputTextMask":"","130_defaultValue":"","130_subLabel":"","130_hint":" ","130_description":"","130_readonly":"No","130_name":"input130","130_qid":130,"130_type":"control_textbox","130_order":77,"131_text":"Doctor\u0027s Address","131_message":"","131_labelAlign":"Auto","131_required":"No","131_size":"50","131_validation":"None","131_maxsize":"","131_inputTextMask":"","131_defaultValue":"","131_subLabel":"","131_hint":" ","131_description":"","131_readonly":"No","131_name":"input131","131_qid":131,"131_type":"control_textbox","131_order":78,"132_text":"Doctor\u0027s Address","132_message":"","132_labelAlign":"Auto","132_required":"No","132_selectedCountry":"","132_description":"","132_subfields":"st1|st2|city|state|zip|country","132_sublabels":{"cc_firstName":"First Name","cc_lastName":"Last Name","cc_number":"Credit Card Number","cc_ccv":"Security Code","cc_exp_month":"Expiration Month","cc_exp_year":"Expiration Year","addr_line1":"Street Address","addr_line2":"Street Address Line 2","city":"City","state":"State / Province","postal":"Postal / Zip Code","country":"Country"},"132_name":"address132","132_qid":132,"132_type":"control_address","132_order":79,"133_text":"Additional notable information","133_message":"","133_labelAlign":"Auto","133_required":"No","133_cols":40,"133_rows":6,"133_validation":"None","133_entryLimit":"None-0","133_maxsize":"","133_defaultValue":"","133_subLabel":"","133_hint":"","133_description":"","133_readonly":"No","133_wysiwyg":"Disable","133_name":"input133","133_qid":133,"133_type":"control_textarea","133_order":80,"134_text":"Fees","134_subHeader":"","134_headerType":"Default","134_name":"clickTo134","134_qid":134,"134_type":"control_head","134_order":81,"135_text":"\u003cp\u003eA non-refundable \u003cstrong\u003e$25 registration fee\u003c/strong\u003e applies per student.\u003c/p\u003e\n\n\u003cp\u003eClubs are offered in seasonal sessions throughout the school year. \u003cstrong\u003eHebrew School students receive a 50% discounted rate, and JELC Pre-K Student receive a 25% discounted\u0026nbsp;rate.\u003c/strong\u003e\u003c/p\u003e\n\n\u003chr\u003e\n\u003ch3\u003e\u003cstrong\u003eMondays\u003c/strong\u003e\u003c/h3\u003e\n\n\u003cul\u003e\n\t\u003cli\u003e\u003cstrong\u003eSTEM/Science:\u003c/strong\u003e Oct. 5 \u0026ndash; Nov. 23 (7 weeks) \u0026ndash; \u003cstrong\u003e$63 / $95 / $126\u003c/strong\u003e\u003c/li\u003e\n\t\u003cli\u003e\u003cstrong\u003eDrama:\u003c/strong\u003e Nov. 30 \u0026ndash; Apr. 12 (14 weeks) \u0026ndash; \u003cstrong\u003e$126 / $190 / $252\u003c/strong\u003e\u003c/li\u003e\n\t\u003cli\u003e\u003cstrong\u003eSports \u0026amp; Movement:\u003c/strong\u003e Apr. 19 \u0026ndash; June 7 (6 weeks) \u0026ndash; \u003cstrong\u003e$54 / $81\u0026nbsp;/ $108\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\n\u003chr\u003e\n\u003ch3\u003e\u003cstrong\u003eThursdays\u003c/strong\u003e\u003c/h3\u003e\n\n\u003cul\u003e\n\t\u003cli\u003e\u003cstrong\u003eBaking:\u003c/strong\u003e Oct. 8 \u0026ndash; Nov. 19 (7 weeks) \u0026ndash; \u003cstrong\u003e$63 / $95 / $126\u003c/strong\u003e\u003c/li\u003e\n\t\u003cli\u003e\u003cstrong\u003eHebrew Language:\u003c/strong\u003e Dec. 3 \u0026ndash; Jan. 28 (7 weeks) \u0026ndash; \u003cstrong\u003e$63 / $95 / $126\u003c/strong\u003e\u003c/li\u003e\n\t\u003cli\u003e\u003cstrong\u003eArt:\u003c/strong\u003e Feb. 4 \u0026ndash; Apr. 8 (7 weeks) \u0026ndash; \u003cstrong\u003e$63 / $95 / $126\u003c/strong\u003e\u003c/li\u003e\n\t\u003cli\u003e\u003cstrong\u003eGymnastics:\u003c/strong\u003e Apr. 15 \u0026ndash; June 3 (6\u0026nbsp;weeks) \u0026ndash; \u003cstrong\u003e$54 / $81\u0026nbsp;/ $108\u003c/strong\u003e\u003c/li\u003e\n\u003c/ul\u003e\n\n\u003chr\u003e\n\u003cp\u003e\u003cem\u003ePrices shown as \u003cstrong\u003eChabad\u003c/strong\u003e\u0026nbsp;\u003c/em\u003e\u003cstrong\u003e\u003cem\u003eHebrew School Student / JELC Pre-K Student / Non-Hebrew School Student\u003c/em\u003e\u003c/strong\u003e\u003cem\u003e.\u003c/em\u003e\u003c/p\u003e\n","135_name":"doubleclickTo","135_qid":135,"135_type":"control_text","135_order":82,"136_text":"Payment","136_subHeader":"","136_headerType":"Default","136_name":"clickTo136","136_qid":136,"136_type":"control_head","136_order":83,"84_labelAlign":"Auto","84_text":"Total","84_partialPayEnabled":"No","84_partialPayType":"percent","84_partialPayMinimum":"10","84_required":"No","84_offsetGiftEnabled":"No","84_offsetGift":3,"84_name":"total","84_qid":84,"84_type":"control_totalamount","84_order":84,"83_text":"Payment","83_message":"","83_labelAlign":"Auto","83_required":"No","83_duplicatable":false,"83_selectedCountry":"","83_description":"","83_sublabels":{"cc_firstName":"First Name","cc_lastName":"Last Name","cc_type":"Credit Card Type","cc_number":"Credit Card Number","cc_ccv":"Security Code","cc_nameOnCard":"Name on Card","cc_IdNumber":"Israel Identity Number","cc_exp_month":"Expiration Month","cc_exp_year":"Expiration Year","eCheck_bankName":"Bank Name","eCheck_routingNumber":"Routing Number","eCheck_accountNumber":"Account Number","eCheck_accountType":"Account Type","addr_line1":"Street Address","addr_line2":"Street Address Line 2","city":"City","state":"State / Province","postal":"Postal / Zip Code","country":"Country"},"83_name":"payment","83_qid":83,"83_type":"control_payform","83_order":85,"83_options":{"currency":"default","creditCard":{"value":"Credit Card","enabled":true,"fields":[{"name":"ccv","value":"CCV","enabled":true},{"name":"nameOnCard","value":"Name on Card","enabled":true},{"name":"billingAddress","value":"Billing Address","enabled":true},{"name":"israelIdentityNumber","value":"Israel Identity Number","enabled":true}],"processorIndex":0,"type":[{"name":"Visa","value":"Visa","enabled":true},{"name":"Mastercard","value":"MasterCard","enabled":true},{"name":"Amex","value":"American Express","enabled":true},{"name":"Discover","value":"Discover","enabled":true},{"name":"Isracard","value":"Isracard","enabled":false}],"payMe":false},"paypal":{"value":"Paypal","enabled":false,"processorIndex":3},"eCheck":{"value":"eCheck","enabled":false},"other":{"value":"Other","enabled":true,"altText":"Zelle","message":"You may submit your Zelle payment to: office@chabadjewishlife.org"}},"2_text":"Submit","2_buttonAlign":"Center","2_clear":"No","2_print":"No","2_name":"submit","2_qid":2,"2_type":"control_button","2_order":86,"form_title":"Suggested Doantion","form_pagetitle":"Form","form_styles":"nova","form_font":"","form_fontsize":"14","form_fontcolor":"","form_optioncolor":"","form_lineSpacing":"12","form_background":"","form_formWidth":"685","form_labelWidth":"150","form_alignment":"Left","form_thankurl":"","form_thanktext":"","form_highlightLine":"Enabled","form_activeRedirect":"default","form_sendpostdata":"No","form_unique":"None","form_uniqueField":"\u003cField Id\u003e","form_status":"Enabled","form_injectCSS":"","form_hideMailEmptyFields":"disable","form_showProgressBar":"disable","form_formStrings":[{"alphabetic":"This field can only contain letters","alphanumeric":"This field can only contain letters and numbers.","confirmClearForm":"Are you sure you want to clear the form?","confirmEmail":"E-mail does not match","email":"Enter a valid e-mail address","generalError":"There are errors on the form. Please fix them before continuing.","generalPageError":"There are errors on this page. Please fix them before continuing.","gradingScoreError":"Score total should only be less than or equal to","incompleteFields":"There are incomplete required fields. Please complete them.","inputCarretErrorA":"Input should not be less than the minimum value:","inputCarretErrorB":"Input should not be greater than the maximum value:","lessThan":"Your score should be less than or equal to","maxDigitsError":"The maximum digits allowed is","maxSelectionsError":"The maximum number of selections allowed is","minSelectionsError":"The minimum required number of selections is","multipleFileUploads_emptyError":"{file} is empty, please select files again without it.","multipleFileUploads_minSizeError":"{file} is too small, minimum file size is {minSizeLimit}.","multipleFileUploads_onLeave":"The files are being uploaded, if you leave now the upload will be cancelled.","multipleFileUploads_sizeError":"{file} is too large, maximum file size is {sizeLimit}.","multipleFileUploads_typeError":"{file} has invalid extension. Only {extensions} are allowed.","numeric":"This field can only contain numeric values","pastDatesDisallowed":"Date must not be in the past.","pleaseWait":"Please wait...","required":"This field is required.","requireEveryRow":"Every row is required.","requireOne":"At least one field required.","submissionLimit":"Sorry! Only one entry is allowed.  Multiple submissions are disabled for this form.","uploadExtensions":"You can only upload following files:","uploadFilesize":"File size cannot be bigger than:"}],"form_limitSubmission":"No Limit","form_expireDate":"No Limit","form_messageOfLimitedForm":"This form is currently unavailable!","form_emails":[],"form_language":"","form_sendEmail":"Yes","form_style":"Default","form_theme":"nova","form_id":6501436,"form_formStringsChanged":"yes","form_slug":6501436,"form_optinDisabled":"true","form_stopHighlight":"Yes","form_conditions":[{"type":"field","link":"Any","terms":[{"field":"7","operator":"greaterThan","value":"1"}],"actions":[{"field":"44","visibility":"Show"},{"field":"43","visibility":"Show"},{"field":"38","visibility":"Show"},{"field":"98","visibility":"Show"},{"field":"75","visibility":"Show"},{"field":"64","visibility":"Show"},{"field":"122","visibility":"Show"},{"field":"68","visibility":"Show"},{"field":"115","visibility":"Show"},{"field":"60","visibility":"Show"},{"field":"89","visibility":"Show"},{"field":"120","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"7","operator":"greaterThan","value":"2"}],"actions":[{"field":"48","visibility":"Show"},{"field":"47","visibility":"Show"},{"field":"46","visibility":"Show"},{"field":"99","visibility":"Show"},{"field":"66","visibility":"Show"},{"field":"58","visibility":"Show"},{"field":"76","visibility":"Show"},{"field":"69","visibility":"Show"},{"field":"121","visibility":"Show"},{"field":"116","visibility":"Show"},{"field":"90","visibility":"Show"},{"field":"123","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"85","operator":"equals","value":"Yes"}],"actions":[{"field":"86","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"53","operator":"equals","value":"No"}],"actions":[{"field":"87","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"97","operator":"equals","value":"No"}],"actions":[{"field":"102","visibility":"Show"},{"field":"104","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"98","operator":"equals","value":"Yes"}],"actions":[{"field":"79","visibility":"Show"},{"field":"80","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"98","operator":"equals","value":"No"}],"actions":[{"field":"106","visibility":"Show"},{"field":"108","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"99","operator":"equals","value":"Yes"}],"actions":[{"field":"81","visibility":"Show"},{"field":"82","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"99","operator":"equals","value":"No"}],"actions":[{"field":"110","visibility":"Show"},{"field":"112","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"97","operator":"equals","value":"Yes"}],"actions":[{"field":"77","visibility":"Show"},{"field":"78","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"97","operator":"equals","value":"My child is a JELC Pre-K Student"}],"actions":[{"field":"137","visibility":"Show"},{"field":"138","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"98","operator":"equals","value":"My child is a JELC Pre-K Student"}],"actions":[{"field":"139","visibility":"Show"},{"field":"140","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"99","operator":"equals","value":"My child is a JELC Pre-K Student"}],"actions":[{"field":"141","visibility":"Show"},{"field":"142","visibility":"Show"}]}]}][0] || {}, window.formJson || {});
window.isSecureForm = true
});

			if (typeof(Userform) ==='undefined')
			{
				Userform={init:function(args){
					$j(function(){
						Userform.init.apply(Userform, [args]);
					})
				},
				setConditions:function(args){
					$j(function(){
						Userform.setConditions.apply(Userform, [args]);
					})
				}};
			}
</script><script src="/net/platform/sitecontrol/admin/publishing/formbuilder/js/vendor/jquery-1.8.0.min.js?v=null" type="text/javascript"></script>
<script src="/net/platform/sitecontrol/admin/publishing/formbuilder/js/vendor/maskedinput.min.js?v=null" type="text/javascript"></script>
<script type="text/javascript">
   Userform.setConditions([{"type":"field","link":"Any","terms":[{"field":"7","operator":"greaterThan","value":"1"}],"actions":[{"field":"44","visibility":"Show"},{"field":"43","visibility":"Show"},{"field":"38","visibility":"Show"},{"field":"98","visibility":"Show"},{"field":"75","visibility":"Show"},{"field":"64","visibility":"Show"},{"field":"122","visibility":"Show"},{"field":"68","visibility":"Show"},{"field":"115","visibility":"Show"},{"field":"60","visibility":"Show"},{"field":"89","visibility":"Show"},{"field":"120","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"7","operator":"greaterThan","value":"2"}],"actions":[{"field":"48","visibility":"Show"},{"field":"47","visibility":"Show"},{"field":"46","visibility":"Show"},{"field":"99","visibility":"Show"},{"field":"66","visibility":"Show"},{"field":"58","visibility":"Show"},{"field":"76","visibility":"Show"},{"field":"69","visibility":"Show"},{"field":"121","visibility":"Show"},{"field":"116","visibility":"Show"},{"field":"90","visibility":"Show"},{"field":"123","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"85","operator":"equals","value":"Yes"}],"actions":[{"field":"86","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"53","operator":"equals","value":"No"}],"actions":[{"field":"87","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"97","operator":"equals","value":"No"}],"actions":[{"field":"102","visibility":"Show"},{"field":"104","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"98","operator":"equals","value":"Yes"}],"actions":[{"field":"79","visibility":"Show"},{"field":"80","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"98","operator":"equals","value":"No"}],"actions":[{"field":"106","visibility":"Show"},{"field":"108","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"99","operator":"equals","value":"Yes"}],"actions":[{"field":"81","visibility":"Show"},{"field":"82","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"99","operator":"equals","value":"No"}],"actions":[{"field":"110","visibility":"Show"},{"field":"112","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"97","operator":"equals","value":"Yes"}],"actions":[{"field":"77","visibility":"Show"},{"field":"78","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"97","operator":"equals","value":"My child is a JELC Pre-K Student"}],"actions":[{"field":"137","visibility":"Show"},{"field":"138","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"98","operator":"equals","value":"My child is a JELC Pre-K Student"}],"actions":[{"field":"139","visibility":"Show"},{"field":"140","visibility":"Show"}]},{"type":"field","link":"Any","terms":[{"field":"99","operator":"equals","value":"My child is a JELC Pre-K Student"}],"actions":[{"field":"141","visibility":"Show"},{"field":"142","visibility":"Show"}]}]);
   Userform.init(function(){
      $('input_7').hint('ex: 2');
      $('input_3').hint('ex: myname@example.com');
      Userform.setPhoneMaskingValidator( 'input_32_full', '(###) ###-####' );
      $('input_33').hint('ex: myname@example.com');
      Userform.alterTexts({"alphabetic":"This field can only contain letters","alphanumeric":"This field can only contain letters and numbers.","confirmClearForm":"Are you sure you want to clear the form?","confirmEmail":"E-mail does not match","email":"Enter a valid e-mail address","generalError":"There are errors on the form. Please fix them before continuing.","generalPageError":"There are errors on this page. Please fix them before continuing.","gradingScoreError":"Score total should only be less than or equal to","incompleteFields":"There are incomplete required fields. Please complete them.","inputCarretErrorA":"Input should not be less than the minimum value:","inputCarretErrorB":"Input should not be greater than the maximum value:","lessThan":"Your score should be less than or equal to","maxDigitsError":"The maximum digits allowed is","maxSelectionsError":"The maximum number of selections allowed is","minSelectionsError":"The minimum required number of selections is","multipleFileUploads_emptyError":"{file} is empty, please select files again without it.","multipleFileUploads_minSizeError":"{file} is too small, minimum file size is {minSizeLimit}.","multipleFileUploads_onLeave":"The files are being uploaded, if you leave now the upload will be cancelled.","multipleFileUploads_sizeError":"{file} is too large, maximum file size is {sizeLimit}.","multipleFileUploads_typeError":"{file} has invalid extension. Only {extensions} are allowed.","numeric":"This field can only contain numeric values","pastDatesDisallowed":"Date must not be in the past.","pleaseWait":"Please wait...","required":"This field is required.","requireEveryRow":"Every row is required.","requireOne":"At least one field required.","submissionLimit":"Sorry! Only one entry is allowed.  Multiple submissions are disabled for this form.","uploadExtensions":"You can only upload following files:","uploadFilesize":"File size cannot be bigger than:"});
   });
</script>
<style type="text/css" id="GenFormStyles">
    .form-label{
        width:150px !important;
    }
    .form-label-left{
        width:150px !important;
    }
    .form-line{
        padding-top:12px;
        padding-bottom:12px;
    }
    .form-label-right{
        width:150px !important;
    }
    .form-all {
        font-size:14px;
    }
.co_body .content .form-all p {
 font-size:14px;

}
@media screen and (max-width: 600px) {.form-label-left{	float:none;	display:block;}.form-buttons-wrapper.button-align-auto{text-indent: 0!important;}}</style>

<form class="userform-form" action="" method="post" name="form_6501436" id="6501436" accept-charset="utf-8"><input type="hidden" name="formID" value="6501436" /><div class="form-all dir_ltr" dir="ltr"><ul class="form-section"><li id="cid_49" class="form-input-wide"> <div class="form-header-group"><h2 id="header_49" class="form-header">The Albert &amp; Temi Horowitz CKids Club</h2></div> </li><li class="form-line" id="id_40"><div id="cid_40" class="form-input-wide"> <div id="text_40" class="form-html"><p style="text-align: center;">Welcome! We are thrilled you are considering joining the Albert &amp; Temi Horowitz CKids Club. Space is limited, and acceptance is prioritized for alumni of the Alan &amp; Tatyana Forman Jewish Early Learning Center and those affiliated with the Chabad Center. If accepted, you will receive the registration form. We look forward to the possibility of having your child(ren) with us!</p>
</div> </div></li><li class="form-line" id="id_7"><div class="form-label-left" id="label_7"><label for="input_7"> Number of children you would like to enroll:<span class="form-required">*</span> </label><label class="label-message" for="input_7"> </label></div><div id="cid_7" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_7" name="q7_number7" style="width:60px" size="5" value="1" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" max="3" data-numbermax="3" /> </div></li><li id="cid_118" class="form-input-wide"> <div class="form-header-group"><h2 id="header_118" class="form-header">Child's Information</h2></div> </li><li class="form-line" id="id_97"><div class="form-label-left" id="label_97"><label for="input_97"> Is your child enrolled at Chabad Hebrew School for the 2026-2027 school year?<span class="form-required">*</span> </label><label class="label-message" for="input_97"> </label></div><div id="cid_97" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_97_0" name="q97_input97" value="Yes" /><label id="label_input_97_0" for="input_97_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_97_1" name="q97_input97" value="No" /><label id="label_input_97_1" for="input_97_1"><span>No</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_97_2" name="q97_input97" value="My child is a JELC Pre-K Student" /><label id="label_input_97_2" for="input_97_2"><span>My child is a JELC Pre-K Student</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_35"><div class="form-label-left" id="label_35"><label for="input_35"> Child's Name:<span class="form-required">*</span> </label><label class="label-message" for="input_35"> </label></div><div id="cid_35" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q35_fullName35[first]" id="first_35" autocomplete="given-name" />  <label class="form-sub-label" for="first_35" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q35_fullName35[last]" id="last_35" autocomplete="family-name" />  <label class="form-sub-label" for="last_35" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_67"><div class="form-label-left" id="label_67"><label for="input_67"> Hebrew Name: </label><label class="label-message" for="input_67"> </label></div><div id="cid_67" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_67" name="q67_input67" size="20" value="" /> </div></li><li class="form-line" id="id_37"><div class="form-label-left" id="label_37"><label for="input_37"> Child's Date of Birth:<span class="form-required">*</span> </label><label class="label-message" for="input_37"> </label></div><div id="cid_37" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q37_birthDate[month]" id="input_37_month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_37_month" id="sublabel_month">Month</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q37_birthDate[day]" id="input_37_day"><option></option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option><option value="13">13</option><option value="14">14</option><option value="15">15</option><option value="16">16</option><option value="17">17</option><option value="18">18</option><option value="19">19</option><option value="20">20</option><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option></select>  <label class="form-sub-label" for="input_37_day" id="sublabel_day">Day</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q37_birthDate[year]" id="input_37_year"><option></option><option value="2026">2026</option><option value="2025">2025</option><option value="2024">2024</option><option value="2023">2023</option><option value="2022">2022</option><option value="2021">2021</option><option value="2020">2020</option><option value="2019">2019</option><option value="2018">2018</option><option value="2017">2017</option><option value="2016">2016</option><option value="2015">2015</option><option value="2014">2014</option><option value="2013">2013</option><option value="2012">2012</option><option value="2011">2011</option><option value="2010">2010</option><option value="2009">2009</option><option value="2008">2008</option><option value="2007">2007</option><option value="2006">2006</option><option value="2005">2005</option><option value="2004">2004</option><option value="2003">2003</option><option value="2002">2002</option><option value="2001">2001</option><option value="2000">2000</option><option value="1999">1999</option><option value="1998">1998</option><option value="1997">1997</option><option value="1996">1996</option><option value="1995">1995</option><option value="1994">1994</option><option value="1993">1993</option><option value="1992">1992</option><option value="1991">1991</option><option value="1990">1990</option><option value="1989">1989</option><option value="1988">1988</option><option value="1987">1987</option><option value="1986">1986</option><option value="1985">1985</option><option value="1984">1984</option><option value="1983">1983</option><option value="1982">1982</option><option value="1981">1981</option><option value="1980">1980</option><option value="1979">1979</option><option value="1978">1978</option><option value="1977">1977</option><option value="1976">1976</option><option value="1975">1975</option><option value="1974">1974</option><option value="1973">1973</option><option value="1972">1972</option><option value="1971">1971</option><option value="1970">1970</option><option value="1969">1969</option><option value="1968">1968</option><option value="1967">1967</option><option value="1966">1966</option><option value="1965">1965</option><option value="1964">1964</option><option value="1963">1963</option><option value="1962">1962</option><option value="1961">1961</option><option value="1960">1960</option><option value="1959">1959</option><option value="1958">1958</option><option value="1957">1957</option><option value="1956">1956</option><option value="1955">1955</option><option value="1954">1954</option><option value="1953">1953</option><option value="1952">1952</option><option value="1951">1951</option><option value="1950">1950</option><option value="1949">1949</option><option value="1948">1948</option><option value="1947">1947</option><option value="1946">1946</option><option value="1945">1945</option><option value="1944">1944</option><option value="1943">1943</option><option value="1942">1942</option><option value="1941">1941</option><option value="1940">1940</option><option value="1939">1939</option><option value="1938">1938</option><option value="1937">1937</option><option value="1936">1936</option><option value="1935">1935</option><option value="1934">1934</option><option value="1933">1933</option><option value="1932">1932</option><option value="1931">1931</option><option value="1930">1930</option><option value="1929">1929</option><option value="1928">1928</option><option value="1927">1927</option><option value="1926">1926</option><option value="1925">1925</option><option value="1924">1924</option><option value="1923">1923</option><option value="1922">1922</option><option value="1921">1921</option><option value="1920">1920</option></select>  <label class="form-sub-label" for="input_37_year" id="sublabel_year">Year</label></span></div> </div></li><li class="form-line" id="id_119"><div class="form-label-left" id="label_119"><label for="input_119"> Gender<span class="form-required">*</span> </label><label class="label-message" for="input_119"> </label></div><div id="cid_119" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_119_0" name="q119_input119" value="Male" /><label id="label_input_119_0" for="input_119_0"><span>Male</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_119_1" name="q119_input119" value="Female" /><label id="label_input_119_1" for="input_119_1"><span>Female</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_42"><div class="form-label-left" id="label_42"><label for="input_42"> Child's Age:<span class="form-required">*</span> </label><label class="label-message" for="input_42"> </label></div><div id="cid_42" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_42" name="q42_number42" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_114"><div class="form-label-left" id="label_114"><label for="input_114"> Current grade at school<span class="form-required">*</span> </label><label class="label-message" for="input_114"> </label></div><div id="cid_114" class="form-input"> <select class="form-dropdown validate[required]" style="width:150px" id="input_114" name="q114_input114"><option value=""></option><option value="PreK">PreK</option><option value="Kindergarten">Kindergarten</option><option value="1st Grade">1st Grade</option><option value="2nd Grade">2nd Grade</option><option value="3rd Grade">3rd Grade</option><option value="4th Grade">4th Grade</option><option value="5th Grade">5th Grade</option><option value="6th Grade">6th Grade</option><option value="7th Grade">7th Grade</option></select> </div></li><li class="form-line" id="id_62"><div class="form-label-left" id="label_62"><label for="input_62"> School: </label><label class="label-message" for="input_62"> </label></div><div id="cid_62" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_62" name="q62_input62" size="20" value="" /> </div></li><li class="form-line" id="id_56"><div class="form-label-left" id="label_56"><label for="input_56"> School District </label><label class="label-message" for="input_56"> </label></div><div id="cid_56" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_56" name="q56_input56" size="20" value="" /> </div></li><li class="form-line" id="id_74"><div class="form-label-left" id="label_74"><label for="input_74"> Any allergies? </label><label class="label-message" for="input_74"> </label></div><div id="cid_74" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_74" name="q74_input74" size="20" value="" /> </div></li><li class="form-line" id="id_77"><div class="form-label-left" id="label_77"><label for="input_77"> Monday 5:30 - 6:30 pm session </label><label class="label-message" for="input_77"> </label></div><div id="cid_77" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_77_0" name="q77_input77[]" value="STEM/Science: 10/5 - 11/23 ($63 for 7 week session)" /><label id="label_input_77_0" for="input_77_0"><span>STEM/Science: 10/5 - 11/23 ($63 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_77_1" name="q77_input77[]" value="Sports and movements: 4/19 - 6/7 ($54 for 6 week session)" /><label id="label_input_77_1" for="input_77_1"><span>Sports and movements: 4/19 - 6/7 ($54 for 6 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_77_2" name="q77_input77[]" value="Drama: 11/30-04/12 ($126 for 14 week session)" /><label id="label_input_77_2" for="input_77_2"><span>Drama: 11/30-04/12 ($126 for 14 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_78"><div class="form-label-left" id="label_78"><label for="input_78"> Thursday 5:30 - 6:30 pm session </label><label class="label-message" for="input_78"> </label></div><div id="cid_78" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_78_0" name="q78_input78[]" value="Baking: 10/8 - 11/19 ($63 for 7 week session)" /><label id="label_input_78_0" for="input_78_0"><span>Baking: 10/8 - 11/19 ($63 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_78_1" name="q78_input78[]" value="Hebrew Language: 12/3 - 1/28 ($63 for 7 week session)" /><label id="label_input_78_1" for="input_78_1"><span>Hebrew Language: 12/3 - 1/28 ($63 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_78_2" name="q78_input78[]" value="Art: 2/4 - 4/8 ($63 for  7 week session)" /><label id="label_input_78_2" for="input_78_2"><span>Art: 2/4 - 4/8 ($63 for  7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_78_3" name="q78_input78[]" value="Gymnastic: 4/15 - 6/3 ($54 for 6 week session)" /><label id="label_input_78_3" for="input_78_3"><span>Gymnastic: 4/15 - 6/3 ($54 for 6 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_137"><div class="form-label-left" id="label_137"><label for="input_137"> Monday 5:30 - 6:30 pm session </label><label class="label-message" for="input_137"> </label></div><div id="cid_137" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_137_0" name="q137_input137[]" value="STEM/Science: 10/5 - 11/23 ($95 for 7 week session)" /><label id="label_input_137_0" for="input_137_0"><span>STEM/Science: 10/5 - 11/23 ($95 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_137_1" name="q137_input137[]" value="Sports and movements: 4/19 - 6/7 ($81 for 6 week session)" /><label id="label_input_137_1" for="input_137_1"><span>Sports and movements: 4/19 - 6/7 ($81 for 6 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_137_2" name="q137_input137[]" value="Drama: 11/30-04/12 ($190 for 14 week session)" /><label id="label_input_137_2" for="input_137_2"><span>Drama: 11/30-04/12 ($190 for 14 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_138"><div class="form-label-left" id="label_138"><label for="input_138"> Thursday 5:30 - 6:30 pm session </label><label class="label-message" for="input_138"> </label></div><div id="cid_138" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_138_0" name="q138_input138[]" value="Baking: 10/8 - 11/19 ($95 for 7 week session)" /><label id="label_input_138_0" for="input_138_0"><span>Baking: 10/8 - 11/19 ($95 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_138_1" name="q138_input138[]" value="Hebrew Language: 12/3 - 1/28 ($95 for 7 week session)" /><label id="label_input_138_1" for="input_138_1"><span>Hebrew Language: 12/3 - 1/28 ($95 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_138_2" name="q138_input138[]" value="Art: 2/4 - 4/8 ($95 for  7 week session)" /><label id="label_input_138_2" for="input_138_2"><span>Art: 2/4 - 4/8 ($95 for  7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_138_3" name="q138_input138[]" value="Gymnastic: 4/15 - 6/3 ($81 for 6 week session)" /><label id="label_input_138_3" for="input_138_3"><span>Gymnastic: 4/15 - 6/3 ($81 for 6 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_102"><div class="form-label-left" id="label_102"><label for="input_102"> Monday 5:30 - 6:30 pm session </label><label class="label-message" for="input_102"> </label></div><div id="cid_102" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_102_0" name="q102_input102[]" value="STEM/Science: 10/5 - 11/23 ($126 for 7 week session)" /><label id="label_input_102_0" for="input_102_0"><span>STEM/Science: 10/5 - 11/23 ($126 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_102_1" name="q102_input102[]" value="Drama: 11/30 - 4/12 ($252 for 14 week session)" /><label id="label_input_102_1" for="input_102_1"><span>Drama: 11/30 - 4/12 ($252 for 14 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_102_2" name="q102_input102[]" value="Sports and movements: 4/19 - 6/7 ($108 for 6 week session)" /><label id="label_input_102_2" for="input_102_2"><span>Sports and movements: 4/19 - 6/7 ($108 for 6 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_104"><div class="form-label-left" id="label_104"><label for="input_104"> Thursday 5:30 - 6:30 pm session </label><label class="label-message" for="input_104"> </label></div><div id="cid_104" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_104_0" name="q104_input104[]" value="Baking: 10/8 - 11/19 ($126 for 7 week session)" /><label id="label_input_104_0" for="input_104_0"><span>Baking: 10/8 - 11/19 ($126 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_104_1" name="q104_input104[]" value="Hebrew Language: 12/3 - 1/28 ($126 for 7 week session)" /><label id="label_input_104_1" for="input_104_1"><span>Hebrew Language: 12/3 - 1/28 ($126 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_104_2" name="q104_input104[]" value="Art: 2/4 - 4/8 ($126 for  7 week session)" /><label id="label_input_104_2" for="input_104_2"><span>Art: 2/4 - 4/8 ($126 for  7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_104_3" name="q104_input104[]" value="Gymanstic: 4/15 - 6/3 ($108 for 6 week session)" /><label id="label_input_104_3" for="input_104_3"><span>Gymanstic: 4/15 - 6/3 ($108 for 6 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_88"><div class="form-label-left" id="label_88"><label for="input_88"> Additional learning opportunities </label><label class="label-message" for="input_88"> </label></div><div id="cid_88" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_88_0" name="q88_input88[]" value="Jewish Learning" /><label id="label_input_88_0" for="input_88_0"><span>Jewish Learning</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_88_1" name="q88_input88[]" value="Hebrew Reading" /><label id="label_input_88_1" for="input_88_1"><span>Hebrew Reading</span></label></span><span class="clearfix"></span></div> </div></li><li id="cid_122" class="form-input-wide"> <div class="form-header-group"><h2 id="header_122" class="form-header">Child 2 Information</h2></div> </li><li class="form-line" id="id_98"><div class="form-label-left" id="label_98"><label for="input_98"> Is your child enrolled at Chabad Hebrew School for the 2026-2027 school year?<span class="form-required">*</span> </label><label class="label-message" for="input_98"> </label></div><div id="cid_98" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_98_0" name="q98_input98" value="Yes" /><label id="label_input_98_0" for="input_98_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_98_1" name="q98_input98" value="No" /><label id="label_input_98_1" for="input_98_1"><span>No</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_98_2" name="q98_input98" value="My child is a JELC Pre-K Student" /><label id="label_input_98_2" for="input_98_2"><span>My child is a JELC Pre-K Student</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_44"><div class="form-label-left" id="label_44"><label for="input_44"> Child 2 Name:<span class="form-required">*</span> </label><label class="label-message" for="input_44"> </label></div><div id="cid_44" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q44_fullName44[first]" id="first_44" autocomplete="given-name" />  <label class="form-sub-label" for="first_44" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q44_fullName44[last]" id="last_44" autocomplete="family-name" />  <label class="form-sub-label" for="last_44" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_68"><div class="form-label-left" id="label_68"><label for="input_68"> Child 2 Hebrew Name:<span class="form-required">*</span> </label><label class="label-message" for="input_68"> </label></div><div id="cid_68" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_68" name="q68_input68" size="20" value="" /> </div></li><li class="form-line" id="id_43"><div class="form-label-left" id="label_43"><label for="input_43"> Child 2: Date of Birth<span class="form-required">*</span> </label><label class="label-message" for="input_43"> </label></div><div id="cid_43" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q43_birthDate43[month]" id="input_43_month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_43_month" id="sublabel_month">Month</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q43_birthDate43[day]" id="input_43_day"><option></option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option><option value="13">13</option><option value="14">14</option><option value="15">15</option><option value="16">16</option><option value="17">17</option><option value="18">18</option><option value="19">19</option><option value="20">20</option><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option></select>  <label class="form-sub-label" for="input_43_day" id="sublabel_day">Day</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q43_birthDate43[year]" id="input_43_year"><option></option><option value="2026">2026</option><option value="2025">2025</option><option value="2024">2024</option><option value="2023">2023</option><option value="2022">2022</option><option value="2021">2021</option><option value="2020">2020</option><option value="2019">2019</option><option value="2018">2018</option><option value="2017">2017</option><option value="2016">2016</option><option value="2015">2015</option><option value="2014">2014</option><option value="2013">2013</option><option value="2012">2012</option><option value="2011">2011</option><option value="2010">2010</option><option value="2009">2009</option><option value="2008">2008</option><option value="2007">2007</option><option value="2006">2006</option><option value="2005">2005</option><option value="2004">2004</option><option value="2003">2003</option><option value="2002">2002</option><option value="2001">2001</option><option value="2000">2000</option><option value="1999">1999</option><option value="1998">1998</option><option value="1997">1997</option><option value="1996">1996</option><option value="1995">1995</option><option value="1994">1994</option><option value="1993">1993</option><option value="1992">1992</option><option value="1991">1991</option><option value="1990">1990</option><option value="1989">1989</option><option value="1988">1988</option><option value="1987">1987</option><option value="1986">1986</option><option value="1985">1985</option><option value="1984">1984</option><option value="1983">1983</option><option value="1982">1982</option><option value="1981">1981</option><option value="1980">1980</option><option value="1979">1979</option><option value="1978">1978</option><option value="1977">1977</option><option value="1976">1976</option><option value="1975">1975</option><option value="1974">1974</option><option value="1973">1973</option><option value="1972">1972</option><option value="1971">1971</option><option value="1970">1970</option><option value="1969">1969</option><option value="1968">1968</option><option value="1967">1967</option><option value="1966">1966</option><option value="1965">1965</option><option value="1964">1964</option><option value="1963">1963</option><option value="1962">1962</option><option value="1961">1961</option><option value="1960">1960</option><option value="1959">1959</option><option value="1958">1958</option><option value="1957">1957</option><option value="1956">1956</option><option value="1955">1955</option><option value="1954">1954</option><option value="1953">1953</option><option value="1952">1952</option><option value="1951">1951</option><option value="1950">1950</option><option value="1949">1949</option><option value="1948">1948</option><option value="1947">1947</option><option value="1946">1946</option><option value="1945">1945</option><option value="1944">1944</option><option value="1943">1943</option><option value="1942">1942</option><option value="1941">1941</option><option value="1940">1940</option><option value="1939">1939</option><option value="1938">1938</option><option value="1937">1937</option><option value="1936">1936</option><option value="1935">1935</option><option value="1934">1934</option><option value="1933">1933</option><option value="1932">1932</option><option value="1931">1931</option><option value="1930">1930</option><option value="1929">1929</option><option value="1928">1928</option><option value="1927">1927</option><option value="1926">1926</option><option value="1925">1925</option><option value="1924">1924</option><option value="1923">1923</option><option value="1922">1922</option><option value="1921">1921</option><option value="1920">1920</option></select>  <label class="form-sub-label" for="input_43_year" id="sublabel_year">Year</label></span></div> </div></li><li class="form-line" id="id_120"><div class="form-label-left" id="label_120"><label for="input_120"> Child 2: Gender<span class="form-required">*</span> </label><label class="label-message" for="input_120"> </label></div><div id="cid_120" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_120_0" name="q120_input120" value="Male" /><label id="label_input_120_0" for="input_120_0"><span>Male</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_120_1" name="q120_input120" value="Female" /><label id="label_input_120_1" for="input_120_1"><span>Female</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_38"><div class="form-label-left" id="label_38"><label for="input_38"> Child 2: Age<span class="form-required">*</span> </label><label class="label-message" for="input_38"> </label></div><div id="cid_38" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_38" name="q38_number" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_115"><div class="form-label-left" id="label_115"><label for="input_115"> Child 2: Current grade at school </label><label class="label-message" for="input_115"> </label></div><div id="cid_115" class="form-input"> <select class="form-dropdown" style="width:150px" id="input_115" name="q115_input115"><option value=""></option><option value="PreK">PreK</option><option value="Kindergarten">Kindergarten</option><option value="1st Grade">1st Grade</option><option value="2nd Grade">2nd Grade</option><option value="3rd Grade">3rd Grade</option><option value="4th Grade">4th Grade</option><option value="5th Grade">5th Grade</option><option value="6th Grade">6th Grade</option><option value="7th Grade">7th Grade</option></select> </div></li><li class="form-line" id="id_64"><div class="form-label-left" id="label_64"><label for="input_64"> Child 2: School </label><label class="label-message" for="input_64"> </label></div><div id="cid_64" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_64" name="q64_input64" size="20" value="" /> </div></li><li class="form-line" id="id_60"><div class="form-label-left" id="label_60"><label for="input_60"> Child 2: School District </label><label class="label-message" for="input_60"> </label></div><div id="cid_60" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_60" name="q60_input60" size="20" value="" /> </div></li><li class="form-line" id="id_75"><div class="form-label-left" id="label_75"><label for="input_75"> Any allergies? </label><label class="label-message" for="input_75"> </label></div><div id="cid_75" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_75" name="q75_input75" size="20" value="" /> </div></li><li class="form-line" id="id_79"><div class="form-label-left" id="label_79"><label for="input_79"> Monday 5:30 - 6:30 pm session </label><label class="label-message" for="input_79"> </label></div><div id="cid_79" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_79_0" name="q79_input79[]" value="STEM/Science: 10/5-11/23 ($63 for 7 week session)" /><label id="label_input_79_0" for="input_79_0"><span>STEM/Science: 10/5-11/23 ($63 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_79_1" name="q79_input79[]" value="Drama: 11/30-04/12 ($126 for 14 week session)" /><label id="label_input_79_1" for="input_79_1"><span>Drama: 11/30-04/12 ($126 for 14 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_79_2" name="q79_input79[]" value="Sports and movements: 04/19- 06/7 ($54 for 6 week session)" /><label id="label_input_79_2" for="input_79_2"><span>Sports and movements: 04/19- 06/7 ($54 for 6 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_80"><div class="form-label-left" id="label_80"><label for="input_80"> Thursday 5:30 - 6:30 pm session </label><label class="label-message" for="input_80"> </label></div><div id="cid_80" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_80_0" name="q80_input80[]" value="Baking: 10/8-11/19 ($63 for 7 week session)" /><label id="label_input_80_0" for="input_80_0"><span>Baking: 10/8-11/19 ($63 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_80_1" name="q80_input80[]" value="Hebrew Language: 12/3-01/28 ($63 for 7 week session)" /><label id="label_input_80_1" for="input_80_1"><span>Hebrew Language: 12/3-01/28 ($63 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_80_2" name="q80_input80[]" value="Art: 02/4-04/8 ($63 for  7 week session)" /><label id="label_input_80_2" for="input_80_2"><span>Art: 02/4-04/8 ($63 for  7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_80_3" name="q80_input80[]" value="Gymnastic: 04/15-06/3 ($54 for 6 week session)" /><label id="label_input_80_3" for="input_80_3"><span>Gymnastic: 04/15-06/3 ($54 for 6 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_139"><div class="form-label-left" id="label_139"><label for="input_139"> Monday 5:30 - 6:30 pm session </label><label class="label-message" for="input_139"> </label></div><div id="cid_139" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_139_0" name="q139_input139[]" value="STEM/Science: 10/5-11/23 ($95 for 7 week session)" /><label id="label_input_139_0" for="input_139_0"><span>STEM/Science: 10/5-11/23 ($95 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_139_1" name="q139_input139[]" value="Drama: 11/30-04/12 ($190 for 14 week session)" /><label id="label_input_139_1" for="input_139_1"><span>Drama: 11/30-04/12 ($190 for 14 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_139_2" name="q139_input139[]" value="Sports and movements: 04/19- 06/7 ($81 for 6 week session)" /><label id="label_input_139_2" for="input_139_2"><span>Sports and movements: 04/19- 06/7 ($81 for 6 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_140"><div class="form-label-left" id="label_140"><label for="input_140"> Thursday 5:30 - 6:30 pm session </label><label class="label-message" for="input_140"> </label></div><div id="cid_140" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_140_0" name="q140_input140[]" value="Baking: 10/8-11/19 ($95 for 7 week session)" /><label id="label_input_140_0" for="input_140_0"><span>Baking: 10/8-11/19 ($95 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_140_1" name="q140_input140[]" value="Hebrew Language: 12/3-01/28 ($95 for 7 week session)" /><label id="label_input_140_1" for="input_140_1"><span>Hebrew Language: 12/3-01/28 ($95 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_140_2" name="q140_input140[]" value="Art: 02/4-04/8 ($95 for  7 week session)" /><label id="label_input_140_2" for="input_140_2"><span>Art: 02/4-04/8 ($95 for  7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_140_3" name="q140_input140[]" value="Gymnastic: 04/15-06/3 ($95 for 7 week session)" /><label id="label_input_140_3" for="input_140_3"><span>Gymnastic: 04/15-06/3 ($95 for 7 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_106"><div class="form-label-left" id="label_106"><label for="input_106"> Monday 5:30 - 6:30 pm session </label><label class="label-message" for="input_106"> </label></div><div id="cid_106" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_106_0" name="q106_input106[]" value="STEM/Science: 10/5-11/23 ($126 for 7 week session)" /><label id="label_input_106_0" for="input_106_0"><span>STEM/Science: 10/5-11/23 ($126 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_106_1" name="q106_input106[]" value="Drama: 11/30-04/12 ($252 for 14 week session)" /><label id="label_input_106_1" for="input_106_1"><span>Drama: 11/30-04/12 ($252 for 14 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_106_2" name="q106_input106[]" value="Sports and movements: 04/19- 06/7 ($108 for 6 week session)" /><label id="label_input_106_2" for="input_106_2"><span>Sports and movements: 04/19- 06/7 ($108 for 6 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_108"><div class="form-label-left" id="label_108"><label for="input_108"> Thursday 5:30 - 6:30 pm session </label><label class="label-message" for="input_108"> </label></div><div id="cid_108" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_108_0" name="q108_input108[]" value="Baking: 10/8-11/19 ($126 for 7 week session)" /><label id="label_input_108_0" for="input_108_0"><span>Baking: 10/8-11/19 ($126 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_108_1" name="q108_input108[]" value="Hebrew Language: 12/3-01/28 ($126 for 7 week session)" /><label id="label_input_108_1" for="input_108_1"><span>Hebrew Language: 12/3-01/28 ($126 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_108_2" name="q108_input108[]" value="Art: 02/4-04/8 ($126 for  7 week session)" /><label id="label_input_108_2" for="input_108_2"><span>Art: 02/4-04/8 ($126 for  7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_108_3" name="q108_input108[]" value="Gymnastic: 04/15-06/3 ($108 for 6 week session)" /><label id="label_input_108_3" for="input_108_3"><span>Gymnastic: 04/15-06/3 ($108 for 6 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_89"><div class="form-label-left" id="label_89"><label for="input_89"> Additional learning opportunities </label><label class="label-message" for="input_89"> </label></div><div id="cid_89" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_89_0" name="q89_input89[]" value="Jewish Learning" /><label id="label_input_89_0" for="input_89_0"><span>Jewish Learning</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_89_1" name="q89_input89[]" value="Hebrew Reading" /><label id="label_input_89_1" for="input_89_1"><span>Hebrew Reading</span></label></span><span class="clearfix"></span></div> </div></li><li id="cid_123" class="form-input-wide"> <div class="form-header-group"><h2 id="header_123" class="form-header">Child 3 Information</h2></div> </li><li class="form-line" id="id_99"><div class="form-label-left" id="label_99"><label for="input_99"> Is your child enrolled at Chabad Hebrew School for the 2026-2027 school year?<span class="form-required">*</span> </label><label class="label-message" for="input_99"> </label></div><div id="cid_99" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_99_0" name="q99_input99" value="Yes" /><label id="label_input_99_0" for="input_99_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_99_1" name="q99_input99" value="No" /><label id="label_input_99_1" for="input_99_1"><span>No</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_99_2" name="q99_input99" value="My child is a JELC Pre-K Student" /><label id="label_input_99_2" for="input_99_2"><span>My child is a JELC Pre-K Student</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_48"><div class="form-label-left" id="label_48"><label for="input_48"> Child 3 Name:<span class="form-required">*</span> </label><label class="label-message" for="input_48"> </label></div><div id="cid_48" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q48_fullName48[first]" id="first_48" autocomplete="given-name" />  <label class="form-sub-label" for="first_48" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q48_fullName48[last]" id="last_48" autocomplete="family-name" />  <label class="form-sub-label" for="last_48" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_69"><div class="form-label-left" id="label_69"><label for="input_69"> Child 3 Hebrew Name<span class="form-required">*</span> </label><label class="label-message" for="input_69"> </label></div><div id="cid_69" class="form-input"> <input type="text" class=" form-textbox validate[required]" data-type="input-textbox" id="input_69" name="q69_input69" size="20" value="" /> </div></li><li class="form-line" id="id_47"><div class="form-label-left" id="label_47"><label for="input_47"> Child 3 Date of Birth:<span class="form-required">*</span> </label><label class="label-message" for="input_47"> </label></div><div id="cid_47" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q47_birthDate47[month]" id="input_47_month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_47_month" id="sublabel_month">Month</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q47_birthDate47[day]" id="input_47_day"><option></option><option value="1">1</option><option value="2">2</option><option value="3">3</option><option value="4">4</option><option value="5">5</option><option value="6">6</option><option value="7">7</option><option value="8">8</option><option value="9">9</option><option value="10">10</option><option value="11">11</option><option value="12">12</option><option value="13">13</option><option value="14">14</option><option value="15">15</option><option value="16">16</option><option value="17">17</option><option value="18">18</option><option value="19">19</option><option value="20">20</option><option value="21">21</option><option value="22">22</option><option value="23">23</option><option value="24">24</option><option value="25">25</option><option value="26">26</option><option value="27">27</option><option value="28">28</option><option value="29">29</option><option value="30">30</option><option value="31">31</option></select>  <label class="form-sub-label" for="input_47_day" id="sublabel_day">Day</label></span><span class="form-sub-label-container"><select autocomplete="nope" class="form-dropdown validate[required]" name="q47_birthDate47[year]" id="input_47_year"><option></option><option value="2026">2026</option><option value="2025">2025</option><option value="2024">2024</option><option value="2023">2023</option><option value="2022">2022</option><option value="2021">2021</option><option value="2020">2020</option><option value="2019">2019</option><option value="2018">2018</option><option value="2017">2017</option><option value="2016">2016</option><option value="2015">2015</option><option value="2014">2014</option><option value="2013">2013</option><option value="2012">2012</option><option value="2011">2011</option><option value="2010">2010</option><option value="2009">2009</option><option value="2008">2008</option><option value="2007">2007</option><option value="2006">2006</option><option value="2005">2005</option><option value="2004">2004</option><option value="2003">2003</option><option value="2002">2002</option><option value="2001">2001</option><option value="2000">2000</option><option value="1999">1999</option><option value="1998">1998</option><option value="1997">1997</option><option value="1996">1996</option><option value="1995">1995</option><option value="1994">1994</option><option value="1993">1993</option><option value="1992">1992</option><option value="1991">1991</option><option value="1990">1990</option><option value="1989">1989</option><option value="1988">1988</option><option value="1987">1987</option><option value="1986">1986</option><option value="1985">1985</option><option value="1984">1984</option><option value="1983">1983</option><option value="1982">1982</option><option value="1981">1981</option><option value="1980">1980</option><option value="1979">1979</option><option value="1978">1978</option><option value="1977">1977</option><option value="1976">1976</option><option value="1975">1975</option><option value="1974">1974</option><option value="1973">1973</option><option value="1972">1972</option><option value="1971">1971</option><option value="1970">1970</option><option value="1969">1969</option><option value="1968">1968</option><option value="1967">1967</option><option value="1966">1966</option><option value="1965">1965</option><option value="1964">1964</option><option value="1963">1963</option><option value="1962">1962</option><option value="1961">1961</option><option value="1960">1960</option><option value="1959">1959</option><option value="1958">1958</option><option value="1957">1957</option><option value="1956">1956</option><option value="1955">1955</option><option value="1954">1954</option><option value="1953">1953</option><option value="1952">1952</option><option value="1951">1951</option><option value="1950">1950</option><option value="1949">1949</option><option value="1948">1948</option><option value="1947">1947</option><option value="1946">1946</option><option value="1945">1945</option><option value="1944">1944</option><option value="1943">1943</option><option value="1942">1942</option><option value="1941">1941</option><option value="1940">1940</option><option value="1939">1939</option><option value="1938">1938</option><option value="1937">1937</option><option value="1936">1936</option><option value="1935">1935</option><option value="1934">1934</option><option value="1933">1933</option><option value="1932">1932</option><option value="1931">1931</option><option value="1930">1930</option><option value="1929">1929</option><option value="1928">1928</option><option value="1927">1927</option><option value="1926">1926</option><option value="1925">1925</option><option value="1924">1924</option><option value="1923">1923</option><option value="1922">1922</option><option value="1921">1921</option><option value="1920">1920</option></select>  <label class="form-sub-label" for="input_47_year" id="sublabel_year">Year</label></span></div> </div></li><li class="form-line" id="id_121"><div class="form-label-left" id="label_121"><label for="input_121"> Child 3: Gender<span class="form-required">*</span> </label><label class="label-message" for="input_121"> </label></div><div id="cid_121" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_121_0" name="q121_input121" value="Male" /><label id="label_input_121_0" for="input_121_0"><span>Male</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_121_1" name="q121_input121" value="Female" /><label id="label_input_121_1" for="input_121_1"><span>Female</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_46"><div class="form-label-left" id="label_46"><label for="input_46"> Child 3 Age<span class="form-required">*</span> </label><label class="label-message" for="input_46"> </label></div><div id="cid_46" class="form-input"> <input type="number" class="form-number-input  form-textbox validate[required]" id="input_46" name="q46_number46" style="width:60px" size="5" value="" data-type="input-number" autocomplete="nope" min="0" data-numbermin="0" /> </div></li><li class="form-line" id="id_116"><div class="form-label-left" id="label_116"><label for="input_116"> Child 3: Current grade at school </label><label class="label-message" for="input_116"> </label></div><div id="cid_116" class="form-input"> <select class="form-dropdown" style="width:150px" id="input_116" name="q116_input116"><option value=""></option><option value="PreK">PreK</option><option value="Kindergarten">Kindergarten</option><option value="1st Grade">1st Grade</option><option value="2nd Grade">2nd Grade</option><option value="3rd Grade">3rd Grade</option><option value="4th Grade">4th Grade</option><option value="5th Grade">5th Grade</option><option value="6th Grade">6th Grade</option><option value="7th Grade">7th Grade</option></select> </div></li><li class="form-line" id="id_66"><div class="form-label-left" id="label_66"><label for="input_66"> Child 3: School </label><label class="label-message" for="input_66"> </label></div><div id="cid_66" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_66" name="q66_input66" size="20" value="" /> </div></li><li class="form-line" id="id_58"><div class="form-label-left" id="label_58"><label for="input_58"> Child 3: School District </label><label class="label-message" for="input_58"> </label></div><div id="cid_58" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_58" name="q58_input58" size="20" value="" /> </div></li><li class="form-line" id="id_76"><div class="form-label-left" id="label_76"><label for="input_76"> Any allergies? </label><label class="label-message" for="input_76"> </label></div><div id="cid_76" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_76" name="q76_input76" size="20" value="" /> </div></li><li class="form-line" id="id_81"><div class="form-label-left" id="label_81"><label for="input_81"> Monday 5:30 - 6:30 pm session </label><label class="label-message" for="input_81"> </label></div><div id="cid_81" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_81_0" name="q81_input81[]" value="STEM/Science: 10/5-11/23 ($63 for 7 week session)" /><label id="label_input_81_0" for="input_81_0"><span>STEM/Science: 10/5-11/23 ($63 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_81_1" name="q81_input81[]" value="Drama: 11/30-04/12 ($126 for 14 week session)" /><label id="label_input_81_1" for="input_81_1"><span>Drama: 11/30-04/12 ($126 for 14 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_81_2" name="q81_input81[]" value="Sports and movements: 04/19- 06/7 ($54 for 6 week session)" /><label id="label_input_81_2" for="input_81_2"><span>Sports and movements: 04/19- 06/7 ($54 for 6 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_82"><div class="form-label-left" id="label_82"><label for="input_82"> Thursday 5:30 - 6:30 pm session </label><label class="label-message" for="input_82"> </label></div><div id="cid_82" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_82_0" name="q82_input82[]" value="Baking: 10/8-11/19 ($63 for 7 week session)" /><label id="label_input_82_0" for="input_82_0"><span>Baking: 10/8-11/19 ($63 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_82_1" name="q82_input82[]" value="Hebrew Language: 12/3-01/28 ($63 for 7 week session)" /><label id="label_input_82_1" for="input_82_1"><span>Hebrew Language: 12/3-01/28 ($63 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_82_2" name="q82_input82[]" value="Art: 02/4-04/8 ($63 for  7 week session)" /><label id="label_input_82_2" for="input_82_2"><span>Art: 02/4-04/8 ($63 for  7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_82_3" name="q82_input82[]" value="Gymnastic: 04/15-06/3 ($54 for 6 week session)" /><label id="label_input_82_3" for="input_82_3"><span>Gymnastic: 04/15-06/3 ($54 for 6 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_141"><div class="form-label-left" id="label_141"><label for="input_141"> Monday 5:30 - 6:30 pm session </label><label class="label-message" for="input_141"> </label></div><div id="cid_141" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_141_0" name="q141_input141[]" value="STEM/Science: 10/5-11/23 ($95 for 7 week session)" /><label id="label_input_141_0" for="input_141_0"><span>STEM/Science: 10/5-11/23 ($95 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_141_1" name="q141_input141[]" value="Drama: 11/30-04/12 ($190 for 14 week session)" /><label id="label_input_141_1" for="input_141_1"><span>Drama: 11/30-04/12 ($190 for 14 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_141_2" name="q141_input141[]" value="Sports and movements: 04/19- 06/7 ($81 for 6 week session)" /><label id="label_input_141_2" for="input_141_2"><span>Sports and movements: 04/19- 06/7 ($81 for 6 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_142"><div class="form-label-left" id="label_142"><label for="input_142"> Thursday 5:30 - 6:30 pm session </label><label class="label-message" for="input_142"> </label></div><div id="cid_142" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_142_0" name="q142_input142[]" value="Baking: 10/8-11/19 ($95 for 7 week session)" /><label id="label_input_142_0" for="input_142_0"><span>Baking: 10/8-11/19 ($95 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_142_1" name="q142_input142[]" value="Hebrew Language: 12/3-01/28 ($95 for 7 week session)" /><label id="label_input_142_1" for="input_142_1"><span>Hebrew Language: 12/3-01/28 ($95 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_142_2" name="q142_input142[]" value="Art: 02/4-04/8 ($95 for  7 week session)" /><label id="label_input_142_2" for="input_142_2"><span>Art: 02/4-04/8 ($95 for  7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_142_3" name="q142_input142[]" value="Gymnastic: 04/15-06/3 ($81 for 6 week session)" /><label id="label_input_142_3" for="input_142_3"><span>Gymnastic: 04/15-06/3 ($81 for 6 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_110"><div class="form-label-left" id="label_110"><label for="input_110"> Monday 5:30 - 6:30 pm session </label><label class="label-message" for="input_110"> </label></div><div id="cid_110" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_110_0" name="q110_input110[]" value="STEM/Science: 10/5-11/23 ($126 for 7 week session)" /><label id="label_input_110_0" for="input_110_0"><span>STEM/Science: 10/5-11/23 ($126 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_110_1" name="q110_input110[]" value="Drama: 11/30-04/12 ($252 for 14 week session)" /><label id="label_input_110_1" for="input_110_1"><span>Drama: 11/30-04/12 ($252 for 14 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_110_2" name="q110_input110[]" value="Sports and movements: 04/19- 06/7 ($108 for 6 week session)" /><label id="label_input_110_2" for="input_110_2"><span>Sports and movements: 04/19- 06/7 ($108 for 6 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_112"><div class="form-label-left" id="label_112"><label for="input_112"> Thursday 5:30 - 6:30 pm session </label><label class="label-message" for="input_112"> </label></div><div id="cid_112" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_112_0" name="q112_input112[]" value="Baking: 10/8-11/19 ($126 for 7 week session)" /><label id="label_input_112_0" for="input_112_0"><span>Baking: 10/8-11/19 ($126 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_112_1" name="q112_input112[]" value="Hebrew Language: 12/3-01/28 ($126 for 7 week session)" /><label id="label_input_112_1" for="input_112_1"><span>Hebrew Language: 12/3-01/28 ($126 for 7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_112_2" name="q112_input112[]" value="Art: 02/4-04/8 ($126 for  7 week session)" /><label id="label_input_112_2" for="input_112_2"><span>Art: 02/4-04/8 ($126 for  7 week session)</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_112_3" name="q112_input112[]" value="Gymnastic: 04/15-06/3 ($108 for 6 week session)" /><label id="label_input_112_3" for="input_112_3"><span>Gymnastic: 04/15-06/3 ($108 for 6 week session)</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_90"><div class="form-label-left" id="label_90"><label for="input_90"> Additional learning opportunities </label><label class="label-message" for="input_90"> </label></div><div id="cid_90" class="form-input"> <div class="form-single-column"><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_90_0" name="q90_input90[]" value="Jewish Learning" /><label id="label_input_90_0" for="input_90_0"><span>Jewish Learning</span></label></span><span class="clearfix"></span><span class="form-checkbox-item clear-left"><input type="checkbox" class="form-checkbox" id="input_90_1" name="q90_input90[]" value="Hebrew Reading" /><label id="label_input_90_1" for="input_90_1"><span>Hebrew Reading</span></label></span><span class="clearfix"></span></div> </div></li><li id="cid_117" class="form-input-wide"> <div class="form-header-group"><h2 id="header_117" class="form-header">Parent's Information</h2></div> </li><li class="form-line" id="id_1"><div class="form-label-left" id="label_1"><label for="input_1"> Mother's Name:<span class="form-required">*</span> </label><label class="label-message" for="input_1"> </label></div><div id="cid_1" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="10" name="q1_fullName[first]" id="first_1" autocomplete="given-name" />  <label class="form-sub-label" for="first_1" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required]" type="text" size="15" name="q1_fullName[last]" id="last_1" autocomplete="family-name" />  <label class="form-sub-label" for="last_1" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_5"><div class="form-label-left" id="label_5"><label for="input_5"> Mother's Cell Phone Number:<span class="form-required">*</span> </label><label class="label-message" for="input_5"> </label></div><div id="cid_5" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q5_phoneNumber[area]" id="input_5_area" autocomplete="tel-area-code" maxlength="5" size="3" />  <label class="form-sub-label" for="input_5_area" id="sublabel_area">Area Code</label></span><span class="form-sub-label-container"><input class="form-textbox validate[required, Numeric]" type="tel" name="q5_phoneNumber[phone]" id="input_5_phone" autocomplete="tel-local" size="8" />  <label class="form-sub-label" for="input_5_phone" id="sublabel_phone">Phone Number</label></span></div> </div></li><li class="form-line" id="id_3"><div class="form-label-left" id="label_3"><label for="input_3"> Mother's E-mail:<span class="form-required">*</span> </label><label class="label-message" for="input_3"> </label></div><div id="cid_3" class="form-input"> <input type="email" class=" form-textbox validate[required, Email]" id="input_3" name="q3_email" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_31"><div class="form-label-left" id="label_31"><label for="input_31"> Father's Name: </label><label class="label-message" for="input_31"> </label></div><div id="cid_31" class="form-input"> <span class="form-sub-label-container"><input class="form-textbox" type="text" size="10" name="q31_fullName31[first]" id="first_31" autocomplete="given-name" />  <label class="form-sub-label" for="first_31" id="sublabel_first">First Name</label></span><span class="form-sub-label-container"><input class="form-textbox" type="text" size="15" name="q31_fullName31[last]" id="last_31" autocomplete="family-name" />  <label class="form-sub-label" for="last_31" id="sublabel_last">Last Name</label></span> </div></li><li class="form-line" id="id_32"><div class="form-label-left" id="label_32"><label for="input_32"> Father's Cell Phone Number: </label><label class="label-message" for="input_32"> </label></div><div id="cid_32" class="form-input"> <div class="dir_ltr"><span class="form-sub-label-container"><input data-type="mask-number" class="mask-phone-number form-textbox" type="tel" name="q32_phoneNumber32[full]" id="input_32_full" autocomplete="tel" />  <label class="form-sub-label" for="input_32_full"><span> </span></label></span></div> </div></li><li class="form-line" id="id_33"><div class="form-label-left" id="label_33"><label for="input_33"> Father's E-mail: </label><label class="label-message" for="input_33"> </label></div><div id="cid_33" class="form-input"> <input type="email" class=" form-textbox validate[Email]" id="input_33" name="q33_email33" size="30" value="" autocomplete="email" /> </div></li><li class="form-line" id="id_34"><div class="form-label-left" id="label_34"><label for="input_34"> Address:<span class="form-required">*</span> </label><label class="label-message" for="input_34"> </label></div><div id="cid_34" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-line" type="text" name="q34_address[addr_line1]" id="input_34_addr_line1" size="46" autocomplete="address-line1" />  <label class="form-sub-label" for="input_34_addr_line1" id="sublabel_34_addr_line1">Street Address</label></span></td></tr><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line no-validation" type="text" name="q34_address[addr_line2]" id="input_34_addr_line2" size="46" autocomplete="address-line2" />  <label class="form-sub-label" for="input_34_addr_line2" id="sublabel_34_addr_line2">Street Address Line 2</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-city" type="text" name="q34_address[city]" id="input_34_city" size="21" autocomplete="address-level2" />  <label class="form-sub-label" for="input_34_city" id="sublabel_34_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-state" type="text" name="q34_address[state]" id="input_34_state" size="22" autocomplete="address-level1" />  <label class="form-sub-label" for="input_34_state" id="sublabel_34_state">State / Province</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox validate[required] form-address-postal" type="text" name="q34_address[postal]" id="input_34_postal" size="10" autocomplete="postal-code" />  <label class="form-sub-label" for="input_34_postal" id="sublabel_34_postal">Postal / Zip Code</label></span></td><td><span class="form-sub-label-container"><select class="form-dropdown validate[required] form-address-country" name="q34_address[country]" id="input_34_country" autocomplete="country-name"><option value="" selected="selected">Please Select</option><option value="United States">United States</option><option value="Afghanistan">Afghanistan</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Anguilla">Anguilla</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</option><option value="Australia">Australia</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="The Bahamas">The Bahamas</option><option value="Bahrain">Bahrain</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option value="Bermuda">Bermuda</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option><option value="Botswana">Botswana</option><option value="Brazil">Brazil</option><option value="Brunei">Brunei</option><option value="Bulgaria">Bulgaria</option><option value="Burkina Faso">Burkina Faso</option><option value="Burundi">Burundi</option><option value="Cambodia">Cambodia</option><option value="Cameroon">Cameroon</option><option value="Canada">Canada</option><option value="Cape Verde">Cape Verde</option><option value="Cayman Islands">Cayman Islands</option><option value="Central African Republic">Central African Republic</option><option value="Chad">Chad</option><option value="Chile">Chile</option><option value="People's Republic of China">People's Republic of China</option><option value="Republic of China">Republic of China</option><option value="Christmas Island">Christmas Island</option><option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option><option value="Colombia">Colombia</option><option value="Comoros">Comoros</option><option value="Congo">Congo</option><option value="Cook Islands">Cook Islands</option><option value="Costa Rica">Costa Rica</option><option value="Cote d'Ivoire">Cote d'Ivoire</option><option value="Croatia">Croatia</option><option value="Cuba">Cuba</option><option value="Cyprus">Cyprus</option><option value="Czech Republic">Czech Republic</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic">Dominican Republic</option><option value="Ecuador">Ecuador</option><option value="Egypt">Egypt</option><option value="El Salvador">El Salvador</option><option value="Equatorial Guinea">Equatorial Guinea</option><option value="Eritrea">Eritrea</option><option value="Estonia">Estonia</option><option value="Eswatini">Eswatini</option><option value="Ethiopia">Ethiopia</option><option value="Falkland Islands">Falkland Islands</option><option value="Faroe Islands">Faroe Islands</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="French Polynesia">French Polynesia</option><option value="Gabon">Gabon</option><option value="The Gambia">The Gambia</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Gibraltar">Gibraltar</option><option value="Greece">Greece</option><option value="Greenland">Greenland</option><option value="Grenada">Grenada</option><option value="Guadeloupe">Guadeloupe</option><option value="Guam">Guam</option><option value="Guatemala">Guatemala</option><option value="Guernsey">Guernsey</option><option value="Guinea">Guinea</option><option value="Guinea-Bissau">Guinea-Bissau</option><option value="Guyana">Guyana</option><option value="Haiti">Haiti</option><option value="Honduras">Honduras</option><option value="Hong Kong">Hong Kong</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Indonesia">Indonesia</option><option value="Iran">Iran</option><option value="Iraq">Iraq</option><option value="Ireland">Ireland</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jersey">Jersey</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kiribati">Kiribati</option><option value="North Korea">North Korea</option><option value="South Korea">South Korea</option><option value="Kosovo">Kosovo</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Laos">Laos</option><option value="Latvia">Latvia</option><option value="Lebanon">Lebanon</option><option value="Lesotho">Lesotho</option><option value="Liberia">Liberia</option><option value="Libya">Libya</option><option value="Liechtenstein">Liechtenstein</option><option value="Lithuania">Lithuania</option><option value="Luxembourg">Luxembourg</option><option value="Macau">Macau</option><option value="Macedonia">Macedonia</option><option value="Madagascar">Madagascar</option><option value="Malawi">Malawi</option><option value="Malaysia">Malaysia</option><option value="Maldives">Maldives</option><option value="Mali">Mali</option><option value="Malta">Malta</option><option value="Marshall Islands">Marshall Islands</option><option value="Martinique">Martinique</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mayotte">Mayotte</option><option value="Mexico">Mexico</option><option value="Micronesia">Micronesia</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Montserrat">Montserrat</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Myanmar">Myanmar</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Nepal">Nepal</option><option value="Netherlands">Netherlands</option><option value="New Caledonia">New Caledonia</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger">Niger</option><option value="Nigeria">Nigeria</option><option value="Niue">Niue</option><option value="Norfolk Island">Norfolk Island</option><option value="Northern Mariana">Northern Mariana</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palau">Palau</option><option value="Panama">Panama</option><option value="Papua New Guinea">Papua New Guinea</option><option value="Paraguay">Paraguay</option><option value="Peru">Peru</option><option value="Philippines">Philippines</option><option value="Pitcairn Islands">Pitcairn Islands</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Romania">Romania</option><option value="Russia">Russia</option><option value="Rwanda">Rwanda</option><option value="Saint Barthelemy">Saint Barthelemy</option><option value="Saint Helena">Saint Helena</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Martin">Saint Martin</option><option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option><option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome and Principe">Sao Tome and Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Slovakia">Slovakia</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="Somaliland">Somaliland</option><option value="South Africa">South Africa</option><option value="South Ossetia">South Ossetia</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Svalbard">Svalbard</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syria">Syria</option><option value="Taiwan">Taiwan</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Thailand">Thailand</option><option value="Timor-Leste">Timor-Leste</option><option value="Togo">Togo</option><option value="Tokelau">Tokelau</option><option value="Tonga">Tonga</option><option value="Trinidad and Tobago">Trinidad and Tobago</option><option value="Tristan da Cunha">Tristan da Cunha</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="Turkmenistan">Turkmenistan</option><option value="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Vatican City">Vatican City</option><option value="Venezuela">Venezuela</option><option value="Vietnam">Vietnam</option><option value="British Virgin Islands">British Virgin Islands</option><option value="US Virgin Islands">US Virgin Islands</option><option value="Wallis and Futuna">Wallis and Futuna</option><option value="Western Sahara">Western Sahara</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option><option value="other">Other</option></select>  <label class="form-sub-label" for="input_34_country" id="sublabel_34_country">Country</label></span></td></tr></tbody></table> </div></li><li class="form-line" id="id_53"><div class="form-label-left" id="label_53"><label for="input_53"> Are both parents Jewish?<span class="form-required">*</span> </label><label class="label-message" for="input_53"> </label></div><div id="cid_53" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_53_0" name="q53_input53" value="Yes" /><label id="label_input_53_0" for="input_53_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_53_1" name="q53_input53" value="No" /><label id="label_input_53_1" for="input_53_1"><span>No</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_87"><div class="form-label-left" id="label_87"><label for="input_87"> If no, which parent is Jewish? </label><label class="label-message" for="input_87"> </label></div><div id="cid_87" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_87_0" name="q87_input87" value="Mother" /><label id="label_input_87_0" for="input_87_0"><span>Mother</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_87_1" name="q87_input87" value="Father" /><label id="label_input_87_1" for="input_87_1"><span>Father</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_85"><div class="form-label-left" id="label_85"><label for="input_85"> Have there been any conversions/adoptions in the family history? </label><label class="label-message" for="input_85"> </label></div><div id="cid_85" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_85_0" name="q85_input85" value="Yes" /><label id="label_input_85_0" for="input_85_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio" id="input_85_1" name="q85_input85" value="No" /><label id="label_input_85_1" for="input_85_1"><span>No</span></label></span><span class="clearfix"></span></div> </div></li><li class="form-line" id="id_86"><div class="form-label-left" id="label_86"><label for="input_86"> If yes, please specify: </label><label class="label-message" for="input_86"> </label></div><div id="cid_86" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_86" name="q86_input86" size="20" value="" /> </div></li><li class="form-line" id="id_72"><div class="form-label-left" id="label_72"><label for="input_72"> Would you be interested in learning more about our holiday programs and Hebrew School?<span class="form-required">*</span> </label><label class="label-message" for="input_72"> </label></div><div id="cid_72" class="form-input"> <div class="form-single-column"><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_72_0" name="q72_input72" value="Yes" /><label id="label_input_72_0" for="input_72_0"><span>Yes</span></label></span><span class="clearfix"></span><span class="form-radio-item clear-left"><input type="radio" class="form-radio validate[required]" id="input_72_1" name="q72_input72" value="No" /><label id="label_input_72_1" for="input_72_1"><span>No</span></label></span><span class="clearfix"></span></div> </div></li><li id="cid_124" class="form-input-wide"> <div class="form-header-group"><h2 id="header_124" class="form-header">Emergency Contact</h2></div> </li><li class="form-line" id="id_125"><div class="form-label-left" id="label_125"><label for="input_125"> Emergency Contact 1 </label><label class="label-message" for="input_125"> </label></div><div id="cid_125" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_125" name="q125_input125" size="50" value="" /> </div></li><li class="form-line" id="id_126"><div class="form-label-left" id="label_126"><label for="input_126"> Emergency Contact 1 Phone </label><label class="label-message" for="input_126"> </label></div><div id="cid_126" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_126" name="q126_input126" size="50" value="" /> </div></li><li class="form-line" id="id_127"><div class="form-label-left" id="label_127"><label for="input_127"> Emergency Contact 2 </label><label class="label-message" for="input_127"> </label></div><div id="cid_127" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_127" name="q127_input127" size="50" value="" /> </div></li><li class="form-line" id="id_128"><div class="form-label-left" id="label_128"><label for="input_128"> Emergency Contact 2 Phone </label><label class="label-message" for="input_128"> </label></div><div id="cid_128" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_128" name="q128_input128" size="50" value="" /> </div></li><li class="form-line" id="id_129"><div class="form-label-left" id="label_129"><label for="input_129"> Doctor's Full Name </label><label class="label-message" for="input_129"> </label></div><div id="cid_129" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_129" name="q129_input129" size="50" value="" /> </div></li><li class="form-line" id="id_130"><div class="form-label-left" id="label_130"><label for="input_130"> Doctor's Phone Number </label><label class="label-message" for="input_130"> </label></div><div id="cid_130" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_130" name="q130_input130" size="50" value="" /> </div></li><li class="form-line" id="id_131"><div class="form-label-left" id="label_131"><label for="input_131"> Doctor's Address </label><label class="label-message" for="input_131"> </label></div><div id="cid_131" class="form-input"> <input type="text" class=" form-textbox" data-type="input-textbox" id="input_131" name="q131_input131" size="50" value="" /> </div></li><li class="form-line" id="id_132"><div class="form-label-left" id="label_132"><label for="input_132"> Doctor's Address </label><label class="label-message" for="input_132"> </label></div><div id="cid_132" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line" type="text" name="q132_address132[addr_line1]" id="input_132_addr_line1" size="46" autocomplete="address-line1" />  <label class="form-sub-label" for="input_132_addr_line1" id="sublabel_132_addr_line1">Street Address</label></span></td></tr><tr><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line no-validation" type="text" name="q132_address132[addr_line2]" id="input_132_addr_line2" size="46" autocomplete="address-line2" />  <label class="form-sub-label" for="input_132_addr_line2" id="sublabel_132_addr_line2">Street Address Line 2</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-city" type="text" name="q132_address132[city]" id="input_132_city" size="21" autocomplete="address-level2" />  <label class="form-sub-label" for="input_132_city" id="sublabel_132_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox form-address-state" type="text" name="q132_address132[state]" id="input_132_state" size="22" autocomplete="address-level1" />  <label class="form-sub-label" for="input_132_state" id="sublabel_132_state">State / Province</label></span></td></tr><tr><td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-postal" type="text" name="q132_address132[postal]" id="input_132_postal" size="10" autocomplete="postal-code" />  <label class="form-sub-label" for="input_132_postal" id="sublabel_132_postal">Postal / Zip Code</label></span></td><td><span class="form-sub-label-container"><select class="form-dropdown form-address-country" name="q132_address132[country]" id="input_132_country" autocomplete="country-name"><option value="" selected="selected">Please Select</option><option value="United States">United States</option><option value="Afghanistan">Afghanistan</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Anguilla">Anguilla</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</option><option value="Australia">Australia</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="The Bahamas">The Bahamas</option><option value="Bahrain">Bahrain</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option value="Bermuda">Bermuda</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option><option value="Botswana">Botswana</option><option value="Brazil">Brazil</option><option value="Brunei">Brunei</option><option value="Bulgaria">Bulgaria</option><option value="Burkina Faso">Burkina Faso</option><option value="Burundi">Burundi</option><option value="Cambodia">Cambodia</option><option value="Cameroon">Cameroon</option><option value="Canada">Canada</option><option value="Cape Verde">Cape Verde</option><option value="Cayman Islands">Cayman Islands</option><option value="Central African Republic">Central African Republic</option><option value="Chad">Chad</option><option value="Chile">Chile</option><option value="People's Republic of China">People's Republic of China</option><option value="Republic of China">Republic of China</option><option value="Christmas Island">Christmas Island</option><option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option><option value="Colombia">Colombia</option><option value="Comoros">Comoros</option><option value="Congo">Congo</option><option value="Cook Islands">Cook Islands</option><option value="Costa Rica">Costa Rica</option><option value="Cote d'Ivoire">Cote d'Ivoire</option><option value="Croatia">Croatia</option><option value="Cuba">Cuba</option><option value="Cyprus">Cyprus</option><option value="Czech Republic">Czech Republic</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic">Dominican Republic</option><option value="Ecuador">Ecuador</option><option value="Egypt">Egypt</option><option value="El Salvador">El Salvador</option><option value="Equatorial Guinea">Equatorial Guinea</option><option value="Eritrea">Eritrea</option><option value="Estonia">Estonia</option><option value="Eswatini">Eswatini</option><option value="Ethiopia">Ethiopia</option><option value="Falkland Islands">Falkland Islands</option><option value="Faroe Islands">Faroe Islands</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="French Polynesia">French Polynesia</option><option value="Gabon">Gabon</option><option value="The Gambia">The Gambia</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Gibraltar">Gibraltar</option><option value="Greece">Greece</option><option value="Greenland">Greenland</option><option value="Grenada">Grenada</option><option value="Guadeloupe">Guadeloupe</option><option value="Guam">Guam</option><option value="Guatemala">Guatemala</option><option value="Guernsey">Guernsey</option><option value="Guinea">Guinea</option><option value="Guinea-Bissau">Guinea-Bissau</option><option value="Guyana">Guyana</option><option value="Haiti">Haiti</option><option value="Honduras">Honduras</option><option value="Hong Kong">Hong Kong</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Indonesia">Indonesia</option><option value="Iran">Iran</option><option value="Iraq">Iraq</option><option value="Ireland">Ireland</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jersey">Jersey</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kiribati">Kiribati</option><option value="North Korea">North Korea</option><option value="South Korea">South Korea</option><option value="Kosovo">Kosovo</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Laos">Laos</option><option value="Latvia">Latvia</option><option value="Lebanon">Lebanon</option><option value="Lesotho">Lesotho</option><option value="Liberia">Liberia</option><option value="Libya">Libya</option><option value="Liechtenstein">Liechtenstein</option><option value="Lithuania">Lithuania</option><option value="Luxembourg">Luxembourg</option><option value="Macau">Macau</option><option value="Macedonia">Macedonia</option><option value="Madagascar">Madagascar</option><option value="Malawi">Malawi</option><option value="Malaysia">Malaysia</option><option value="Maldives">Maldives</option><option value="Mali">Mali</option><option value="Malta">Malta</option><option value="Marshall Islands">Marshall Islands</option><option value="Martinique">Martinique</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mayotte">Mayotte</option><option value="Mexico">Mexico</option><option value="Micronesia">Micronesia</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Montserrat">Montserrat</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Myanmar">Myanmar</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Nepal">Nepal</option><option value="Netherlands">Netherlands</option><option value="New Caledonia">New Caledonia</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger">Niger</option><option value="Nigeria">Nigeria</option><option value="Niue">Niue</option><option value="Norfolk Island">Norfolk Island</option><option value="Northern Mariana">Northern Mariana</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palau">Palau</option><option value="Panama">Panama</option><option value="Papua New Guinea">Papua New Guinea</option><option value="Paraguay">Paraguay</option><option value="Peru">Peru</option><option value="Philippines">Philippines</option><option value="Pitcairn Islands">Pitcairn Islands</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Romania">Romania</option><option value="Russia">Russia</option><option value="Rwanda">Rwanda</option><option value="Saint Barthelemy">Saint Barthelemy</option><option value="Saint Helena">Saint Helena</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Martin">Saint Martin</option><option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option><option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome and Principe">Sao Tome and Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Slovakia">Slovakia</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="Somaliland">Somaliland</option><option value="South Africa">South Africa</option><option value="South Ossetia">South Ossetia</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Svalbard">Svalbard</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syria">Syria</option><option value="Taiwan">Taiwan</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Thailand">Thailand</option><option value="Timor-Leste">Timor-Leste</option><option value="Togo">Togo</option><option value="Tokelau">Tokelau</option><option value="Tonga">Tonga</option><option value="Trinidad and Tobago">Trinidad and Tobago</option><option value="Tristan da Cunha">Tristan da Cunha</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="Turkmenistan">Turkmenistan</option><option value="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Vatican City">Vatican City</option><option value="Venezuela">Venezuela</option><option value="Vietnam">Vietnam</option><option value="British Virgin Islands">British Virgin Islands</option><option value="US Virgin Islands">US Virgin Islands</option><option value="Wallis and Futuna">Wallis and Futuna</option><option value="Western Sahara">Western Sahara</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option><option value="other">Other</option></select>  <label class="form-sub-label" for="input_132_country" id="sublabel_132_country">Country</label></span></td></tr></tbody></table> </div></li><li class="form-line" id="id_133"><div class="form-label-left" id="label_133"><label for="input_133"> Additional notable information </label><label class="label-message" for="input_133"> </label></div><div id="cid_133" class="form-input"> <textarea id="input_133" class="form-textarea" name="q133_input133" cols="40" rows="6"></textarea> </div></li><li id="cid_134" class="form-input-wide"> <div class="form-header-group"><h2 id="header_134" class="form-header">Fees</h2></div> </li><li class="form-line" id="id_135"><div id="cid_135" class="form-input-wide"> <div id="text_135" class="form-html"><p>A non-refundable <strong>$25 registration fee</strong> applies per student.</p>

<p>Clubs are offered in seasonal sessions throughout the school year. <strong>Hebrew School students receive a 50% discounted rate, and JELC Pre-K Student receive a 25% discounted rate.</strong></p>

<hr />
<h3><strong>Mondays</strong></h3>

<ul>
	<li><strong>STEM/Science:</strong> Oct. 5 – Nov. 23 (7 weeks) – <strong>$63 / $95 / $126</strong></li>
	<li><strong>Drama:</strong> Nov. 30 – Apr. 12 (14 weeks) – <strong>$126 / $190 / $252</strong></li>
	<li><strong>Sports &amp; Movement:</strong> Apr. 19 – June 7 (6 weeks) – <strong>$54 / $81 / $108</strong></li>
</ul>

<hr />
<h3><strong>Thursdays</strong></h3>

<ul>
	<li><strong>Baking:</strong> Oct. 8 – Nov. 19 (7 weeks) – <strong>$63 / $95 / $126</strong></li>
	<li><strong>Hebrew Language:</strong> Dec. 3 – Jan. 28 (7 weeks) – <strong>$63 / $95 / $126</strong></li>
	<li><strong>Art:</strong> Feb. 4 – Apr. 8 (7 weeks) – <strong>$63 / $95 / $126</strong></li>
	<li><strong>Gymnastics:</strong> Apr. 15 – June 3 (6 weeks) – <strong>$54 / $81 / $108</strong></li>
</ul>

<hr />
<p><em>Prices shown as <strong>Chabad</strong> </em><strong><em>Hebrew School Student / JELC Pre-K Student / Non-Hebrew School Student</em></strong><em>.</em></p>
</div> </div></li><li id="cid_136" class="form-input-wide"> <div class="form-header-group"><h2 id="header_136" class="form-header">Payment</h2></div> </li><li class="form-line" id="id_84"><div class="form-label-left" id="label_84"><label for="input_84"> Total </label></div><div id="cid_84" class="form-input"> <div id="total_amount">$0.00 </div> </div></li><li class="form-line" id="id_83"><div class="form-label-left" id="label_83"><label for="input_83"> Payment </label><label class="label-message" for="input_83"> </label></div><div id="cid_83" class="form-input"> <table summary="" class="form-address-table" border="0" cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2" class="form-payment-methods form-multiple-column"><span class="form-radio-item"><input class="paymentMethod form-radio validate[paymentMethod] form-radio" type="radio" id="input_83_creditCard" name="q83_payment[payment_method]" value="creditCard" onclick="BuildSource.creditCard(this)" /><label for="input_83_creditCard">Credit Card</label> </span><span class="form-radio-item"><input class="paymentMethod form-radio validate[paymentMethod] form-radio" type="radio" id="input_83_other" name="q83_payment[payment_method]" value="other" onclick="BuildSource.other(this)" /><label for="input_83_other">Zelle</label> </span></td></tr><tr class="credit_card hide"><th colspan="2">Credit Card</th></tr><tr class="credit_card hide"><td colspan="2" style="padding:0"><table cellpadding="0" cellspacing="0"><tbody><tr><td colspan="2"><span class="form-sub-label-container">  <label class="form-sub-label">We accept Visa, MasterCard, American Express, Discover</label></span><div class="cc-icons"><div class="cc-icon visa-icon"></div><div class="cc-icon mastercard-icon"></div><div class="cc-icon amex-icon"></div><div class="cc-icon discover-icon"></div></div><input type="hidden" name="q83_payment[cc_type]" id="input_83_cc_type" value="" /></td></tr><tr><td><div class="cc-field-wrapper"><span class="form-sub-label-container"><input class="form-textbox form-creditcard js-cc-number validate[visible, creditcard]" type="text" name="q83_payment[cc_number]" id="input_83_cc_number" autocomplete="cc-number" size="20" />  <label class="form-sub-label" for="input_83_cc_number" id="sublabel_cc_number">Credit Card Number</label></span></div></td><td class="cc_ccv "><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q83_payment[cc_ccv]" id="input_83_cc_ccv" autocomplete="cc-csc" size="6" />  <label class="form-sub-label" for="input_83_cc_ccv" id="sublabel_cc_ccv">Security Code</label></span></td></tr><tr><td colspan="2" class="cc_name_on_card "><span class="form-sub-label-container"><input class="form-textbox validate[visible]" type="text" name="q83_payment[cc_nameOnCard]" id="input_83_cc_nameOnCard" autocomplete="cc-name" size="33" />  <label class="form-sub-label" for="input_83_cc_nameOnCard" id="sublabel_cc_nameOnCard">Name on Card</label></span></td></tr><tr class="credit_card hide"><td colspan=""><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q83_payment[cc_exp_month]" id="input_83_cc_exp_month" autocomplete="cc-exp-month"><option></option><option value="1">1 - January</option><option value="2">2 - February</option><option value="3">3 - March</option><option value="4">4 - April</option><option value="5">5 - May</option><option value="6">6 - June</option><option value="7">7 - July</option><option value="8">8 - August</option><option value="9">9 - September</option><option value="10">10 - October</option><option value="11">11 - November</option><option value="12">12 - December</option></select>  <label class="form-sub-label" for="input_83_cc_exp_month" id="sublabel_cc_exp_month">Expiration Month</label></span></td><td><span class="form-sub-label-container"><select class="form-textbox validate[visible]" name="q83_payment[cc_exp_year]" id="input_83_cc_exp_year" autocomplete="cc-exp-year"><option></option><option value="2026">2026</option><option value="2027">2027</option><option value="2028">2028</option><option value="2029">2029</option><option value="2030">2030</option><option value="2031">2031</option><option value="2032">2032</option><option value="2033">2033</option><option value="2034">2034</option><option value="2035">2035</option></select>  <label class="form-sub-label" for="input_83_cc_exp_year" id="sublabel_cc_exp_year">Expiration Year</label></span></td></tr></tbody></table></td></tr><tr class="other hide"><td colspan="2">You may submit your Zelle payment to: office@chabadjewishlife.org</td></tr><tr class="billing_address hide"><th colspan="2">Billing Address</th></tr><tr class="billing_address hide"><td colspan="2"><span class="form-sub-label-container"><input class="form-textbox form-address-line" type="text" name="q83_payment[addr_line1]" id="input_83_addr_line1" autocomplete="billing address-line1" />  <label class="form-sub-label" for="input_83_addr_line1" id="sublabel_83_addr_line1">Street Address</label></span></td></tr><tr class="billing_address hide"><td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-city" type="text" name="q83_payment[city]" id="input_83_city" autocomplete="billing address-level2" />  <label class="form-sub-label" for="input_83_city" id="sublabel_83_city">City</label></span></td><td><span class="form-sub-label-container"><input class="form-textbox form-address-state" type="text" name="q83_payment[state]" id="input_83_state" autocomplete="billing address-level1" />  <label class="form-sub-label" for="input_83_state" id="sublabel_83_state">State / Province</label></span></td></tr><tr class="billing_address hide"><td width="50%"><span class="form-sub-label-container"><input class="form-textbox form-address-postal" type="text" name="q83_payment[postal]" id="input_83_postal" size="10" autocomplete="billing postal-code" />  <label class="form-sub-label" for="input_83_postal" id="sublabel_83_postal">Postal / Zip Code</label></span></td><td><span class="form-sub-label-container"><select class="form-dropdown form-address-country" name="q83_payment[country]" id="input_83_country" autocomplete="billing country-name"><option value="" selected="selected">Please Select</option><option value="United States">United States</option><option value="Afghanistan">Afghanistan</option><option value="Albania">Albania</option><option value="Algeria">Algeria</option><option value="American Samoa">American Samoa</option><option value="Andorra">Andorra</option><option value="Angola">Angola</option><option value="Anguilla">Anguilla</option><option value="Antigua and Barbuda">Antigua and Barbuda</option><option value="Argentina">Argentina</option><option value="Armenia">Armenia</option><option value="Aruba">Aruba</option><option value="Australia">Australia</option><option value="Austria">Austria</option><option value="Azerbaijan">Azerbaijan</option><option value="The Bahamas">The Bahamas</option><option value="Bahrain">Bahrain</option><option value="Bangladesh">Bangladesh</option><option value="Barbados">Barbados</option><option value="Belarus">Belarus</option><option value="Belgium">Belgium</option><option value="Belize">Belize</option><option value="Benin">Benin</option><option value="Bermuda">Bermuda</option><option value="Bhutan">Bhutan</option><option value="Bolivia">Bolivia</option><option value="Bosnia and Herzegovina">Bosnia and Herzegovina</option><option value="Botswana">Botswana</option><option value="Brazil">Brazil</option><option value="Brunei">Brunei</option><option value="Bulgaria">Bulgaria</option><option value="Burkina Faso">Burkina Faso</option><option value="Burundi">Burundi</option><option value="Cambodia">Cambodia</option><option value="Cameroon">Cameroon</option><option value="Canada">Canada</option><option value="Cape Verde">Cape Verde</option><option value="Cayman Islands">Cayman Islands</option><option value="Central African Republic">Central African Republic</option><option value="Chad">Chad</option><option value="Chile">Chile</option><option value="People's Republic of China">People's Republic of China</option><option value="Republic of China">Republic of China</option><option value="Christmas Island">Christmas Island</option><option value="Cocos (Keeling) Islands">Cocos (Keeling) Islands</option><option value="Colombia">Colombia</option><option value="Comoros">Comoros</option><option value="Congo">Congo</option><option value="Cook Islands">Cook Islands</option><option value="Costa Rica">Costa Rica</option><option value="Cote d'Ivoire">Cote d'Ivoire</option><option value="Croatia">Croatia</option><option value="Cuba">Cuba</option><option value="Cyprus">Cyprus</option><option value="Czech Republic">Czech Republic</option><option value="Denmark">Denmark</option><option value="Djibouti">Djibouti</option><option value="Dominica">Dominica</option><option value="Dominican Republic">Dominican Republic</option><option value="Ecuador">Ecuador</option><option value="Egypt">Egypt</option><option value="El Salvador">El Salvador</option><option value="Equatorial Guinea">Equatorial Guinea</option><option value="Eritrea">Eritrea</option><option value="Estonia">Estonia</option><option value="Eswatini">Eswatini</option><option value="Ethiopia">Ethiopia</option><option value="Falkland Islands">Falkland Islands</option><option value="Faroe Islands">Faroe Islands</option><option value="Fiji">Fiji</option><option value="Finland">Finland</option><option value="France">France</option><option value="French Polynesia">French Polynesia</option><option value="Gabon">Gabon</option><option value="The Gambia">The Gambia</option><option value="Georgia">Georgia</option><option value="Germany">Germany</option><option value="Ghana">Ghana</option><option value="Gibraltar">Gibraltar</option><option value="Greece">Greece</option><option value="Greenland">Greenland</option><option value="Grenada">Grenada</option><option value="Guadeloupe">Guadeloupe</option><option value="Guam">Guam</option><option value="Guatemala">Guatemala</option><option value="Guernsey">Guernsey</option><option value="Guinea">Guinea</option><option value="Guinea-Bissau">Guinea-Bissau</option><option value="Guyana">Guyana</option><option value="Haiti">Haiti</option><option value="Honduras">Honduras</option><option value="Hong Kong">Hong Kong</option><option value="Hungary">Hungary</option><option value="Iceland">Iceland</option><option value="India">India</option><option value="Indonesia">Indonesia</option><option value="Iran">Iran</option><option value="Iraq">Iraq</option><option value="Ireland">Ireland</option><option value="Israel">Israel</option><option value="Italy">Italy</option><option value="Jamaica">Jamaica</option><option value="Japan">Japan</option><option value="Jersey">Jersey</option><option value="Jordan">Jordan</option><option value="Kazakhstan">Kazakhstan</option><option value="Kenya">Kenya</option><option value="Kiribati">Kiribati</option><option value="North Korea">North Korea</option><option value="South Korea">South Korea</option><option value="Kosovo">Kosovo</option><option value="Kuwait">Kuwait</option><option value="Kyrgyzstan">Kyrgyzstan</option><option value="Laos">Laos</option><option value="Latvia">Latvia</option><option value="Lebanon">Lebanon</option><option value="Lesotho">Lesotho</option><option value="Liberia">Liberia</option><option value="Libya">Libya</option><option value="Liechtenstein">Liechtenstein</option><option value="Lithuania">Lithuania</option><option value="Luxembourg">Luxembourg</option><option value="Macau">Macau</option><option value="Macedonia">Macedonia</option><option value="Madagascar">Madagascar</option><option value="Malawi">Malawi</option><option value="Malaysia">Malaysia</option><option value="Maldives">Maldives</option><option value="Mali">Mali</option><option value="Malta">Malta</option><option value="Marshall Islands">Marshall Islands</option><option value="Martinique">Martinique</option><option value="Mauritania">Mauritania</option><option value="Mauritius">Mauritius</option><option value="Mayotte">Mayotte</option><option value="Mexico">Mexico</option><option value="Micronesia">Micronesia</option><option value="Moldova">Moldova</option><option value="Monaco">Monaco</option><option value="Mongolia">Mongolia</option><option value="Montenegro">Montenegro</option><option value="Montserrat">Montserrat</option><option value="Morocco">Morocco</option><option value="Mozambique">Mozambique</option><option value="Myanmar">Myanmar</option><option value="Namibia">Namibia</option><option value="Nauru">Nauru</option><option value="Nepal">Nepal</option><option value="Netherlands">Netherlands</option><option value="New Caledonia">New Caledonia</option><option value="New Zealand">New Zealand</option><option value="Nicaragua">Nicaragua</option><option value="Niger">Niger</option><option value="Nigeria">Nigeria</option><option value="Niue">Niue</option><option value="Norfolk Island">Norfolk Island</option><option value="Northern Mariana">Northern Mariana</option><option value="Norway">Norway</option><option value="Oman">Oman</option><option value="Pakistan">Pakistan</option><option value="Palau">Palau</option><option value="Panama">Panama</option><option value="Papua New Guinea">Papua New Guinea</option><option value="Paraguay">Paraguay</option><option value="Peru">Peru</option><option value="Philippines">Philippines</option><option value="Pitcairn Islands">Pitcairn Islands</option><option value="Poland">Poland</option><option value="Portugal">Portugal</option><option value="Puerto Rico">Puerto Rico</option><option value="Qatar">Qatar</option><option value="Romania">Romania</option><option value="Russia">Russia</option><option value="Rwanda">Rwanda</option><option value="Saint Barthelemy">Saint Barthelemy</option><option value="Saint Helena">Saint Helena</option><option value="Saint Kitts and Nevis">Saint Kitts and Nevis</option><option value="Saint Lucia">Saint Lucia</option><option value="Saint Martin">Saint Martin</option><option value="Saint Pierre and Miquelon">Saint Pierre and Miquelon</option><option value="Saint Vincent and the Grenadines">Saint Vincent and the Grenadines</option><option value="Samoa">Samoa</option><option value="San Marino">San Marino</option><option value="Sao Tome and Principe">Sao Tome and Principe</option><option value="Saudi Arabia">Saudi Arabia</option><option value="Senegal">Senegal</option><option value="Serbia">Serbia</option><option value="Seychelles">Seychelles</option><option value="Sierra Leone">Sierra Leone</option><option value="Singapore">Singapore</option><option value="Slovakia">Slovakia</option><option value="Slovenia">Slovenia</option><option value="Solomon Islands">Solomon Islands</option><option value="Somalia">Somalia</option><option value="Somaliland">Somaliland</option><option value="South Africa">South Africa</option><option value="South Ossetia">South Ossetia</option><option value="Spain">Spain</option><option value="Sri Lanka">Sri Lanka</option><option value="Sudan">Sudan</option><option value="Suriname">Suriname</option><option value="Svalbard">Svalbard</option><option value="Sweden">Sweden</option><option value="Switzerland">Switzerland</option><option value="Syria">Syria</option><option value="Taiwan">Taiwan</option><option value="Tajikistan">Tajikistan</option><option value="Tanzania">Tanzania</option><option value="Thailand">Thailand</option><option value="Timor-Leste">Timor-Leste</option><option value="Togo">Togo</option><option value="Tokelau">Tokelau</option><option value="Tonga">Tonga</option><option value="Trinidad and Tobago">Trinidad and Tobago</option><option value="Tristan da Cunha">Tristan da Cunha</option><option value="Tunisia">Tunisia</option><option value="Turkey">Turkey</option><option value="Turkmenistan">Turkmenistan</option><option value="Turks and Caicos Islands">Turks and Caicos Islands</option><option value="Tuvalu">Tuvalu</option><option value="Uganda">Uganda</option><option value="Ukraine">Ukraine</option><option value="United Arab Emirates">United Arab Emirates</option><option value="United Kingdom">United Kingdom</option><option value="Uruguay">Uruguay</option><option value="Uzbekistan">Uzbekistan</option><option value="Vanuatu">Vanuatu</option><option value="Vatican City">Vatican City</option><option value="Venezuela">Venezuela</option><option value="Vietnam">Vietnam</option><option value="British Virgin Islands">British Virgin Islands</option><option value="US Virgin Islands">US Virgin Islands</option><option value="Wallis and Futuna">Wallis and Futuna</option><option value="Western Sahara">Western Sahara</option><option value="Yemen">Yemen</option><option value="Zambia">Zambia</option><option value="Zimbabwe">Zimbabwe</option><option value="other">Other</option></select>  <label class="form-sub-label" for="input_83_country" id="sublabel_83_country">Country</label></span></td></tr></tbody></table> </div></li><li class="form-line" id="id_2"><div id="cid_2" class="form-input-wide"> <div style="text-align: center;" class="form-buttons-wrapper button-align-center"><button id="input_2" type="submit" class="form-submit-button  form-submit-button-none;">Submit</button></div> </div></li><li style="display:none">Should be Empty: <input type="text" name="website" value="" /></li></ul></div><input type="hidden" id="simple_spc" name="simple_spc" value="6501436" /><script type="text/javascript">document.getElementById("si"+"mple"+"_spc").value = "6501436-6501436";</script><div>


<script>
	var recaptchaIsEnterprise = false;
		 var recaptchaV2Key = "6LcG_TcUAAAAAKAVgwgW39ujc9OCjXSoQYFIA-Su";

</script>

	<input type="hidden" class="js-recaptcha-input" name="cdo-captcha-response" value="" data-div-id="6b178dbb-cb24-4f66-a93b-05185cbe7177" data-processed="false" />
	<div class="js-recaptcha-wrapper" id="6b178dbb-cb24-4f66-a93b-05185cbe7177"></div>	
</div></form></div>
<div class="center small">
	<img valign="absbottom" src="https://w2.chabad.org/images/global/icons/lock.gif" width="16" height="16" alt="Secure"> This page uses TLS encryption to keep your data secure.
</div>
	<div class="break_floats"></div>
	

<div class="content-footer">
	
	
	
	
	
	
</div>
	</article>

		</div>
	</div>
</div>
						
						<div class="break_floats"></div>
						
					</div>
				</div>
				
				
				
			</div>
			
			<!-- BEGIN FOOTER -->
</div>
</div>

<div>
<div class="FooterContainer">

<footer class="px-4 py-6 md:px-8 bg-purple">
<div class="flex flex-col justify-between">
<div class="mb-3 text-center md:text-right md:mb-0">
<div class="flex justify-center gap-2 mt-4 text-center">

<a href="https://www.facebook.com/JewishELC/" class="text-white opacity-60 hover:opacity-100"> 
<img src="https://w2.chabad.org/images/Shluchim/minisites/themes/ckids/nBVt12218478.svg" alt="facebook" class="w-6 h-6" /></a>

 
<a href="https://www.instagram.com/jewishelc/" class="text-white opacity-60 hover:opacity-100"> 
<img src="https://w2.chabad.org/images/Shluchim/minisites/themes/ckids/VpCL12218477.svg" alt="instagram" class="w-6 h-6" /></a>
 
<a href="https://chat.whatsapp.com/IwF ocwQcjuPIUX 7AfEZ" class="text-white opacity-60 hover:opacity-100"> 
<img src="https://w2.chabad.org/images/Shluchim/minisites/themes/ckids/QbQl12218476.svg" alt="whatsapp" class="w-6 h-6" /></a></div>
<div class="flex justify-center text-lg text-white text-center uppercase">
<strong class="font-bold">
The Albert & Temi Horowitz CKids After School Club </strong>
<span class="sm\:ml-3px ml-3px"> 
Merrick and surrounding areas </span></div>
<div class="text-xs text-white">
<br/>
</div>
</div>
</div>
</footer>
</div>
</div>
</div>
</div>
<!-- END FOOTER -->
		</div>
		
		<aside class="page-tools-sidebar js-page-tools-sidebar hide_for_print">
<div class="page-tools js-page-tools-menu">
<div class="page-tools__section page-tools__section--share">
<a class="page-tools__tool js-share-popup page-tools__tool--facebook" data-share-url="https://www.facebook.com/dialog/share?app_id=188669250943&amp;display=popup&amp;href=https%3a%2f%2fwww.chabadjewishlife.org%2ftemplates%2farticlecco_cdo%2faid%2f6501436%2fjewish%2fRegistration-Form.htm%23utm_medium%3dpage_tools%26utm_content%3ddesktop%26utm_source%3dFB">
				<i class="fa fa-facebook"></i>
			</a>
<a class="page-tools__tool js-share-popup page-tools__tool--twitter" data-share-url="https://twitter.com/intent/tweet?text=Registration+Form+-+Chabad+Center+for+Jewish+Life&amp;url=https%3a%2f%2fwww.chabadjewishlife.org%2ftemplates%2farticlecco_cdo%2faid%2f6501436%2fjewish%2fRegistration-Form.htm%23utm_medium%3dpage_tools%26utm_content%3ddesktop%26utm_source%3dtwitter&amp;via=Chabad">
				<i class="fa fa-twitter"></i>
			</a>
<a class="page-tools__tool js-share-popup page-tools__tool--whatsapp d-lg-none js-share-whatsapp" data-share-url="whatsapp://send?text=Registration+Form+-+Chabad+Center+for+Jewish+Life https%3a%2f%2fwww.chabadjewishlife.org%2ftemplates%2farticlecco_cdo%2faid%2f6501436%2fjewish%2fRegistration-Form.htm%23utm_medium%3dpage_tools%26utm_content%3ddesktop%26utm_source%3dwhatsapp">
				<i class="fa fa-whatsapp">
					<svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 50 50" fill="#128c7e" width="1em" height="1em"><path d="M25 2C12.318 2 2 12.318 2 25c0 3.96 1.023 7.854 2.963 11.29L2.037 46.73c-.096.343-.003.711.245.966.191.197.451.304.718.304.08 0 .161-.01.24-.029l10.896-2.699C17.463 47.058 21.21 48 25 48c12.682 0 23-10.318 23-23S37.682 2 25 2zm11.57 31.116c-.492 1.362-2.852 2.605-3.986 2.772-1.018.149-2.306.213-3.72-.231-.857-.27-1.957-.628-3.366-1.229-5.923-2.526-9.791-8.415-10.087-8.804-.295-.389-2.411-3.161-2.411-6.03s1.525-4.28 2.067-4.864c.542-.584 1.181-.73 1.575-.73s.787.005 1.132.021c.363.018.85-.137 1.329 1.001.492 1.168 1.673 4.037 1.819 4.33.148.292.246.633.05 1.022s-.294.632-.59.973-.62.76-.886 1.022c-.296.291-.603.606-.259 1.19s1.529 2.493 3.285 4.039c2.255 1.986 4.158 2.602 4.748 2.894.59.292.935.243 1.279-.146.344-.39 1.476-1.703 1.869-2.286s.787-.487 1.329-.292c.542.194 3.445 1.604 4.035 1.896.59.292.984.438 1.132.681.148.242.148 1.41-.344 2.771z"/></svg>
				</i>
			</a>
<a class="page-tools__tool js-share-popup page-tools__tool--pinterest d-none d-lg-block" data-share-url="http://pinterest.com/pin/create/button/?url=https%3a%2f%2fwww.chabadjewishlife.org%2ftemplates%2farticlecco_cdo%2faid%2f6501436%2fjewish%2fRegistration-Form.htm%23utm_medium%3dpage_tools%26utm_content%3ddesktop%26utm_source%3dpinterest&amp;description=Registration+Form+-+Chabad+Center+for+Jewish+Life">
				<i class="fa fa-pinterest"></i>
			</a>
<a class="page-tools__tool" onclick="showEmailLayer(this);">
<i class="fa fa-envelope"></i>
</a>
</div>
<div class="page-tools__section page-tools__section--other js-page-tool-other">
<div class="page-tools__tool popover-parent d-lg-block">
<div class="popover popover--right align_left nowrap">
<div class="popover__content">
<label class="bold bottom_margin block">
Print Options:
</label>
<form class="vcenter" name="print-form" onsubmit="coPrint(event, 6495296);return false;">
<div>
<label><input type="checkbox" name="print-green"><span title="Save paper and ink">Print without images <i class="fa fa-leaf text-green"></i></span></label>
</div>
<br/>
<div class="center">
<button class="co-button page-tools__print-button">Print</button>
</div>
</form>
</div>
</div>
<i class="fa fa-print"></i>
</div>
</div>
</div>
<div class="js-fab-wrapper fab-wrapper">
<div class="fab">
<i class="fab-icon"></i>
</div>
</div>
</aside>
<!-- END CACHE -->
	</div>

	</div>

	<div id="BodyContainer">
		<div class="g960 footer">
			<div class="poweredby large_bottom_margin">
				


	<div class="footer3"><b>Chabad Center for Jewish Life - a Project of Maimonides Educational Center • 2174 Hewlett Avenue Suite 101 • Merrick, NY 11566-3606 • 516-833-3057  •  100% of all donations benefit Chabad Center for Jewish Life -  EIN: 02-0707290</b></div>
	<img src="https://w2.chabad.org/images/global/spacer.gif" width="1" height="6" border="0" /><br />




Powered by <a href="https://www.chabad.org/" target="_new" class="">Chabad.org</a> &copy; 1993-2026 <a href="/4026210" target="_blank" class="privacy-link">Privacy Policy</a>




			</div>
		</div>
	</div>
	
	

	
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/os/jquery-latest.min.js?v=278824AF"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/os/jquery/jquery.inputmask.min.js?v=BF33D3B4"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/co/dist/CoLib.js?v=CC07618E"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/WebComponents/bundles/magen-cdo-global.js?v=5457FBE7"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/modules/pagetools.js?v=930B07AB"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/custom/multimedia/infolayer.js?v=ED1B8531"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/templates/forms/userform.js?v=E69144BF"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/article/comments/reply-form-controller.js?v=DC70C970"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/custom/commentsloader.js?v=AD6AAB79"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/custom/minisites.js?v=F38E4DA5"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/custom/subscribeprompt.js?v=86D84DC2"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/templates/FormDecoder.js?v=83AF6F1A"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/custom/deprecated.js?v=D506A83E"></script>
<script type="text/javascript" src="https://w2.chabad.org/scripts/js/OverrideJSDocumentWrite.js?v=9A0227AA"></script><script>$j = $j.fn ? $j : jQuery;$j(()=>{$q.forEach(f=>{try{f.call(window);}catch(ex){console.error(ex);}});})</script>
	

<script  language="javascript" type="text/javascript"> Co.Settings      = {CacheClassName:'js-cache-default',MosadName:'Chabad Center for Jewish Life'}; Co.ArticleId     = '6501436';Co.SectionId     = 1416127;Co.PartnerSiteId = 0;Co.SiteId        = 3616;Co.IsMobilePage  = false;Co.IsResponsive  = false;Co.DbDomain      = 'ChabadJewishLife.org';Co.LanguageCode  = '';Co.LoginStatus   = 'None';</script>
	
	

</body>
</html>