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Youth Bat Mitzvah Club

BMC Registration Form

Bat Mitzvah Girl:
Full Name*
First NameHebrew NameLast Name
Age*
Grade*
School*
Previous Jewish Education*
Birth Date*This will help us accurately calculate your Jewish birthday
MonthDayYear
at HourMinutes
E-mailIf applicable
Cell Phone NumberIf applicable
Area CodePhone Number
Severe Allergies
Parents:
Father*
First NameHebrew NameLast Name
Contact Cell Number*
Area CodePhone Number
Contact E-mail*
Mother*
First NameHebrew NameLast Name
Contact Cell Number*
Area CodePhone Number
Contact E-mail*
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Are the birth parents of your daughter Jewish?*
FatherMotherBoth
Previous Family Conversion/Adoption*If yes, please explain
Total Fee*
$200

Payment*

Credit Card Cash/Check

Postal / Zip Code

Country

Comments/Questions
For additional information email Chana@TheChabadCenter.org
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