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Growing
Together

ב"ה

Mommy & Me Registration

Mommy & Me Registration

Chabad Jewish Center - Boise, Idaho
Acknowledgement*

Yes! I want to register my child.
Child Name*

First Name Last Name
Child Jewish Name

First Name Last Name
Birth Date*

Month Day Year
Mother Name*

First Name Last Name
Mother Religion*
Father Name

First Name Last Name
Father Religion

Address*

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

Home Phone

Area Code Phone Number
Mother Cell Phone*

Area Code Phone Number
Father Cell Phone

Area Code Phone Number
E-mail*
I would like to receive news and updates by email
Are there any adoptions or conversions in the family? (If yes, please describe in comments below)*

NoYes
Is there any information concerning your child that is important for the directors of Mommy & Me to know? (e.g.: asthma, food allergies, adoptions, etc.)
Agreement*

All registrations are pending administrative review and space availability. If we are not able to accept your registration, you will be refunded in full.
Date & Time

Month Day Year
at Hour Minutes
Signature*

First Name Last Name
FEES

$15 for one session

$180 for 2019 winter/spring semester

$360 Sponsor
Amount*

$15$180$360

Payment*

Credit Card Paypal Check

Postal / Zip Code

Country

Should be Empty:

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2014-2015 Photos

Updates

Now accepting moms and children for 2019.

Highlights

Sensory Stimulation

Social Development

Jewish Environment

Mommy & Me is a project of the Chabad Jewish Center of Idaho.