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ב"ה

Programs Pre Bar Mitzvah Club

Birthday Club

Child's Full Name*

First Name Last Name
Child's Birth Date*

Month Day Year
What time of day was the child born?*
Child Hebrew Bday, if known
School Child Attends*
Mother's Full Name*

First Name Last Name
Mother's Hebrew Name*

First Name Last Name
Mother's Birthday*

Month Day Year
What time of day Mother born?*
Mother's Hebrew Birthday, if known
Mother's Phone Number*

Area Code Phone Number
Mother's E-mail*
Father's Full Name*

First Name Last Name
Father's Hebrew Name*

First Name Last Name
Father's Birth Date*

Month Day Year
What time of day Father born?*
Father's Hebrew Birthday, if known
Father's Phone Number*

Area Code Phone Number
Father's E-mail*
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