Registration

1. Children’s Information
Child *

First Name Last Name
Birth Date*

Month Day Year
Hebrew Birth Date
Gender*

MaleFemale
Current School Child Attends
Does your child have any allergies or medical needs? (please specify, including any medications)
Does you child have any learning or behavioural needs? (please describe)
Child 2

First Name Last Name
Birth Date

Month Day Year
Hebrew Birth Date
Gender

MaleFemale
Current School Child Attends
Does your child have any allergies or medical needs? (please specify, including any medications)
Does you child have any learning or behavioural needs? (please describe)
2. Parent Information
Mother's Name*

First Name Last Name
Phone Number*

Address*

E-mail*
I consent to photos of my child being used on the cheder's social media platforms (Facebook and Instagram)
I would like to receive news and updates from Chabad Lubavitch of West Hampstead by email. I understand that information I provide to Chabad Lubavitch of West Hampstead will be used according to its Privacy Policy and I can unsubscribe at any time.
3. Payment
Number of kids
Amount* The total amount of the program is £650. You can pay a £100 deposit and then the remaining £550 in two installments later on. For two children the price is £1,200

£100£650
Amount for 2* The total amount of the program for two is £1200. You can pay a £200 deposit and then the remaining £1000 in two installments later on.

£200£1200
100% of the proceeds of this donation or payment benefit Chabad of West Hampstead
If needed, scholarships are available. For more info please contact [email protected]

Payment*

Credit Card Paypal

Postal / Zip Code

Country

Total

£0.00

Yes, I'd like to donate the cost of processing this transaction by adding 3%
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1. Children’s Information