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I AM SO EXCITED FOR BAT MITZVAH CLUB!

SIGN ME UP NOW!!!

First Name
Last Name
Hebrew Name

School Attending

Grade
Address City/State/Zip
Girls Cell Phone Girl's Email
Date of Birth Time of Birth

AM PM

How did you hear about BMC?

PARENT INFORMATION
Mother's Name
Mother's Hebrew Name
Home Phone
Mother's Cell Phone
Father's Name
Father's Hebrew Name
Father's Cell Phone
Primary Contact Parent Mother Father
Best way to contact me

Home Phone Cell Text E-mail:

Child resides with:

If other, please specify:

GENERAL INFORMATION
Is the natural mother of the child Jewish? Yes No
Is the mother's mother Jewish? Yes No
Is the natural father of the child Jewish? Yes No
Is the father's mother Jewish? Yes No

Have there been any conversions or adoptions in the family history? 

If yes, please send all backup information & documentation. Please note, all conversions must be made through a registered Beth Din that is certified by the Israel Rabbinate.
Has your child attended Hebrew School before?
If so, where and for how long?
Special Instructions (allergies, etc):
Emergency Contact Name:

Phone number:

Persons authorized to pick up my child:

What are some of the goals you hope your child will achieve through being part of the Bat Mitzvah Club?

FIELD TRIP RELEASE FORM

From time to time, as part of the entire educational philosophy and experience at Bat Mitzvah Club, your daughter will be participating in field trips and other off-site activities. Parents will typically be notified of upcoming trips and their cost, if applicable, in advance via email. Please complete the following release form to allow your daughter to participate in these very valuable educational experiences.

I hereby authorize my child to participate in trips conducted by Bat Mitzvah Club for the academic year of 2015-2016.

Please check box: I agree. Initial Here:

PAYMENTS

BAT MITZVAH CLUB MEMBERSHIP: Chabad Members: $575, Community: $675

- Scholarships Available -

We accept cash, checks and credit card payments*.

Thank you for registering for Bat Mitzvah Club.

We will contact you shortly for payment.

WELCOME TO BMC!


* 3% Processing fee for all credit card payments.

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