Child Information Last Name First Name Hebrew Name Date of Birth Age Child's Email What school does your child attend? Grade entering: Parent Information Mother's Name Home Phone Work Phone Cell Phone Email Occupation Address City State Zip Father's Name Home Phone Work Phone Cell Phone Email Occupation Address (if different than above) City State Zip I heard about BMC from: BMC Payment The cost for BMC is $180.00 per year Credit Card Information First Name Last Name Credit Card Number Billing Address City State, Zip Charge Amount Exp Date 01 02 03 04 05 06 07 08 09 10 11 12 2018 2019 2020 2021 2022 2023 2024 2025 CVV I will send a check to Chabad of Potomac,. 11621 Seven Locks Rd., Potomac, MD 20854: We Look Forward to a Fun Filled and Enriching Program! This page uses 128 bit SSL encryption to keep your data secure.
