Parent/Guardian 1 Information:

Parent 1 First Name *

Parent 1 Last Name *

Cell Number *

Parent 1 Email Address *

Please be sure to write your FULL street address and apartment number if applicable

Street Address *

City (Primary) *

State (Primary) *

Postal Code (Primary) *

Jewish by: *

Birth Choice

(If by choice, please email a conversion certificate to wendy@stamfordchabad.org)

Click save, and you will then be redirected to fill out Parent 2 information

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