Mommy and Me

Mommy & Me Registration Form

We are excited to announce a 4-Week Mommy & Me Session happening this June!

Theme: Exploring My Jewish Five Senses

Circle time, music, bubbles, crafts, and more!

Mondays | 10:00 -11:00 am | Located at Chabad of the Beaches 570 W. Walnut, Long Beach, NY
Full Name*
First Name Last Name
E-mail*
Phone Number*
1 Child's Name*
First Name Last Name
1 Child's Birthday*

Month Day Year
at Hour Minutes
2 Child's Name
First Name Last Name
2 Child’s Birthday

Month Day Year
at Hour Minutes
Class Registration
Each class is $10 per family.

Monday, June 8 ($10)Monday, June 15 ($10)Monday, June 22 ($10)Monday, June 29 ($10)Sign up for all four classes ($35)
Partner with us and sponsor a Mommy & Me class or session!

Contribute Towards a Class — $36Sponsor a class: $180
Photo Permission - We love capturing special Mommy & Me moments. Sharing these photos helps inspire other moms to join. Are you comfortable with us posting pictures?

Yes, no problem!No, thank youDepends — please ask me first
Questions or comments:
I would like to receive news and updates by email
Total

$0.00

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

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