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Bat Mitzvah Registration

Bat Mitzvah Registration

 Email

Bat Mitzvah Club Registration

Family Name
First Name
Date of Birth
Night/Day
Hebrew Name
Address
Postal Code
Telephone (home)
School attending
Mother's Name
Mother's Hebrew Name
Mother's cell #
Mother's email
Business name and telephone
Father's Name
Father's Hebrew Name
Father's cell #
Father's email
Business name and telephone
Has your daughter had any other Hebrew education
Is there any medical problem, disability, and/ or allergy
Parent Status
Payment method ($69 registration fee)
Name on card
Card Number
Expiration date (mm/yy)

I hereby certify that all information given above is true and correct and that the Bat Mitzvah girl is Jewish by birth or by conversion by an Orthodox Rabbi

Parent's Initials

 Email
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