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Bat Mitzvah Club

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Child's Information
Full English Name
Hebrew Name
Full Home Address
DOB
Time of Day Born
Jewish Birth Date (if known)
Current Grade
Current Age
Name of School
Best way to contact my child in between meetings (please specify if child has email and/or cell phone)
What are some things that you and/or your child hope to gain, by joining the Bat Mitzvah Club?
Parent's Information
Father's Name
Cell Phone
Email
Mother's Name
Cell Phone
Email
Girl's biological mother is

Jewish from birth Not Jewish Converted
Maternal grandmother is

Jewish from birth Not Jewish Converted
Emergency Information
Does your child have any allergies and/or medical conditions we should be aware of?
Emergency Contact Person and number (in case either parent can’t be reached)
Payment Information
Fee: $360/year, and $100/supplies and materials fee.
Pay in full now, $460 Divide payment in two: $230 in January and $230 in May
Total

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