Bar Mitzvah Club Registration

Please fill out this form as an initial registration for Bar Mitzvah Club.

Confirmation of acceptance will be acknowledged only after this registration form is reviewed and an acceptance letter is received.

Child Profile
First
Last
Hebrew name
DOB            
School currently attending
Grade entering
Is child's biological mother Jewish?
Any conversions or adoptions in the family?
Bris?

Contact Information
Address
City
State
Zip
Home Phone
Email
Mother's Name
Mother's Cell
Father's Name
Father's Cell

Payment & Fees:
Fees: $50 for the Spring Semester
I will be paying by: Cerdit Card    Check
Card Type
Card Number
Expiration Date