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Children & Teens

Mommy & Me Music Appreciation

MOMMY & ME MUSIC APPRECIATION

Tuesdays 10:15 am- 11:15 am

At Chabad Manhattan Beach 134 West End Ave.

Click here to see schedule of classes.

Call/text Shula for more details at 646 - 413-9092
Mommy & Me Registration Form
1. The Child
Child Name*
First Name Last Name
Hebrew Name
Date of Birth*

Month Day Year
Time of Birth* To look up the Hebrew Date
Hour Minutes
Child's Age*
2. The Parents
Father's Name*
First Name Last Name
Father's Cell*

Area Code Phone Number
Father's Email*
Mother's Name*
First Name Last Name
Mother's Cell*

Area Code Phone Number
Mother's Email*
Mother's Facebook Name
Mother's Instagram Name
Are both Parents Jewish?*
Please Explain, Who is Jewish?

Home Address*

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

Are Parents Currently Married?*
Any Adoptions in the Family?*
If yes Please Explain
Any Conversions in the Family?*
If yes Please Explain
Anything to be concerned?* (ex: asthma, food allergies)
Permission to Post Pictures Online*
3. Club Membership
Fee*

$20
How did you hear about us?

Social MediaFriendCall / Txt

Payment*

Credit Card Other

Postal / Zip Code

Country

I would like to receive news and updates by email
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