Chessed Club

Child Name*

First NameLast Name

Birth Date*

Date

School*

Grade*

Shul / Synagogue affiliated with:*

Mother Name*

Mother Cell Number*

Please enter a valid phone number.

Email to Receive Confirmation

example@example.com

All Chessed Club updates are sent via WhatsApp*

I have added Hadassah Geisinsky 516-458-3694 to my contacts

Does your daughter have any allergies or medical conditions we should be award of? If yes, please describe them and indicate special precautions or care needed:*

Chessed Club Registration Payment *

Registration

$65.00

Enter coupon

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country