Register - Beth Menachem Chabad of Newton

Full Year Tuition (All 18 classes): $375

Student Name		Hebrew Name
Last Name		Address
City, Zip & State		Date of Birth
Grade		School
Student Cell		Student Email
Mother's Name		Father's Name
Mother's Phone		Father's Phone
Mother's Email		Father's Email
Emergency Contact Person		Emergency Contact Phone
Best way to reach me for reminders is text email

Optional Donation supporting youth activities		Payment Schedule
Payment Method		Card Number
Expiration		CVV Code
Cardholder's Name		Biling Zip
Amount to Charge Today		Comments
Check can be mailed to Beth Menachem Chabad of Newton • 349 Dedham Street • Newton, MA 02459