BMC Registration Form - TheChabadCenter.org

SEVEN SUNDAY SESSIONS

Nov 24 | Dec 15 | Jan 12 | Feb 9 | Mar 9 | April 6 | May 11
Bat Mitzvah Girl Info:
Full Name*
First Name Hebrew Name Last Name
Age*
Grade*
School*
Previous Jewish Education*
Birth Date* This will help us accurately calculate her Jewish birthday

Month Day Year
at Hour Minutes
Her E-mail If applicable
Her Cell Number If applicable

Area Code Phone Number
Allergies For food allergies please elaborate
Parent Information:
Father*
First Name Hebrew Name Last Name
Contact Cell Number*

Area Code Phone Number
Contact E-mail
Mother*
First Name Hebrew Name Last Name
Contact Cell Number*

Area Code Phone Number
Contact E-mail*
I would like to receive news and updates by email
Are the birth parents of your daughter Jewish?*

FatherMotherBoth
Previous Family Conversion/Adoption* If yes, please explain
Total Fee*

$200
Total

$0.00

Payment*

Credit Card Cash/Check

Postal / Zip Code

Country

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Bat Mitzvah Girl Info: