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child(ren)'s first name 

last name 

child(ren)'s age 

SESSION ONE

 Full Session ($80)
Or select individual session dates below ($15/Class) 
 Nov 3rd  Nov 10th   Nov 17th 
 Nov 24th   Dec 8th  Dec 15th 

 

SESSION TWO

 Full Session ($80)
Or select individual session dates below ($15/Class) 
 Jan 5th  Jan 12th   Jan 19th 
 Jan 26th   Feb 2nd  Feb 9 

 

SESSION THREE

 Full Session ($80)
Or select individual session dates below ($15/Class) 
 March 1  March 8   March 15th 
 March 22   March 29  

 

 Amount to Charge to CC or being mailed in.

First Name* 

Last Name* 

Address Line 1* 

Address Line 2 

City*  State  Post Code*  

Phone 

Email Address* 

Please charge my Credit Card

Card Type 

Card Number 

Security Code 

Expiration Date   

I prefer to pay with Check.  I will mail a check to Chabad of Montville 325Changebridge Road, Pine Book NJ, 07058

Questions and/or comments: