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Waitlist 2025

This form is currently closed.

1. Parent information
Father's info*
Fathers First Name Fathers Last Name
Cell Phone*

Area Code Phone Number
Work Phone

Area Code Phone Number
E-mail*
Mother's info*
Mothers First Name Mothers Last Name
Cell Phone*

Area Code Phone Number
Work Phone

Area Code Phone Number
E-mail* Primary email
2. Child's Information
Child 1*
First Name Middle Name Last Name
Birth Date*

Month Day Year
Gender*

MaleFemale
Grade Entering August 2025*
School Currently Attending *
*

Full Summer ( June 24 - August 7)Week 1 (June 24 - June 27)Week 2 (June 30 - July 3)Week 3 (July 7 - July 11)Week 4 (July 14 - July 18)Week 5 (July 21 - July 25)Week 6 (July 28 - August 1)Week 7 (August 4 - August 7)
Child 2
First Name Middle Name Last Name
Birth Date

Month Day Year
Gender

MaleFemale
Grade Entering August 2025
School Currently Attending
*

Full Summer ( June 24 - August 7)Week 1 (June 24 - June 27)Week 2 (June 30 - July 3)Week 3 (July 7 - July 11)Week 4 (July 14 - July 18)Week 5 (July 21 - July 25)Week 6 (July 28 - August 1)Week 7 (August 4 - August 7)
Child 3
First Name Middle Name Last Name
Birth Date

Month Day Year
Gender

MaleFemale
Grade Entering August 2025
School Currently Attending
*

Full Summer ( June 24 - August 7)Week 1 (June 24 - June 27)Week 2 (June 30 - July 3)Week 3 (July 7 - July 11)Week 4 (July 14 - July 18)Week 5 (July 21 - July 25)Week 6 (July 28 - August 1)Week 7 (August 4 - August 7)
Child 4
First Name Middle Name Last Name
Birth Date

Month Day Year
Gender

MaleFemale
School Currently Attending
Grade Entering August 2025
*

Full Summer ( June 24 - August 7)Week 1 (June 24 - June 27)Week 2 (June 30 - July 3)Week 3 (July 7 - July 11)Week 4 (July 14 - July 18)Week 5 (July 21 - July 25)Week 6 (July 28 - August 1)Week 7 (August 4 - August 7)
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Chabad of East Hollywood

1350 Harrison Street Hollywood, FL 33020

954-687-7225

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