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Chabad Youth Group Sign Up

 Father's Name 
 Mother's Name
 Postal Code
 Email Address

 Child's First Name
 Child's Last Name
 Birthday (mm/dd/yyyy)
 Cell Phone
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Chai 5

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 Emergency Contact Number

 I/We hereby authorize our child to participate in all Chabad Youth Group activities in and out of club grounds. 


Charge:  $36.00 annual membership 
Free for students of Chabad Hebrew School and Campers of CGI

Bill Me
Please charge my card in the  amount of: $36
My child is a camper/student

Please keep my card on file and charge me for each session that my child attends.

Form of payment:

 Card Number
Expiration Date

 Please provide any additional comments here: 

For more information please call (407-354-3660)

 or email:


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