Printed from ChabadVI.org

BMC Registration form

BMC Registration form

BAT MITZVAH CLUB REGISTRATION FORM

Child's Information

Name

Hebrew Name

Address

Phone

Email


School


Grade

Age

Birthday


Time of Birth


 

Parent's Information

Parent's Name

Relationship

Home phone

Work Phone

Cell Phone

Email

Parent's Information

Parent's Name

Relationship

Home Phone

Work Phone

Cell Phone

Email

 

Emergency Information

Please list any medical condition or allergy information we should be aware of

Child's Preferences

What are some things you hope to gain from the BMC?

Which of these activities do you enjoy most (Write 1 for the most and 10 for the least)?

Writing

Public speaking

Acting

Group leading

Singing / Playing a musical instrument

Dancing

Sports

Drawing/Crafting

Cooking/Baking

Party planning

 

Tell us 5 WORDS that pop in your head when you hear the words bat mitzvah (don’t worry – there’s no wrong answers!).

 


 

Fee Schedule

$175 (Includes all sessions, supplies & refreshments)
$360 - Sponsor (Includes all sessions, supplies & refreshments)

Payment Type:
Please charge my credit card monthly (7 months - November-May)
Please charge my credit card once for the whole amount

 

Payment Information:

Name On Card
Card Type
Card Number
Expiration Date
CVV Security Code

Comments

 

 

 

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