Bat Mitzvah Club Registration 2023-2024

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Welcome!

We are so excited you chose to join our Bat Mitzvah Club 2023-2024 at The Shul.

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Bat Mitzvah Club Girl Information

* First Name

* Last Name

Hebrew Name

* Address

* State

* Zip Code

* Cell Phone

* Email Address

Name of school attending this upcoming year

* Age

* English Birthday

* Time of Day

AMPM

Hebrew Birthday (if known)

Allergies

Family Information

* Father's First Name

* Father's Last Name

Father's Cell Phone

Father's Email

Mother's First Name

Mother's Last Name

Mother's Cell Phone

Mother's Email

Please Select Your Preferred Contact for Program Updates and Information:

FatherMotherBoth

Is the biological mother of the child Jewish?

YesNo

Were there any conversions in your family?

YesNo

If yes, please explain

If yes, please upload conversion documents

Emergency Contact Information

Name

Phone Number

Relationship

Payment

* Payment Plan A (6 monthly installments) $150 monthly

Please Select OneNot applicable.Bat Mitzvah Club (6 monthly installments).On the confirm payment page be sure to select Pay this amount: 6 payments.
Thank you

Payment Plan B (Full Payment) $900

Not applicable. Bat Mitzvah Club (full payment)On the confirm payment page be sure to select Pay this amount: Once Now.
Thank you

* Email Address

* Cell Phone Number

Payment Plan Selection:

Plan A: The entire amount indicated in "Total Amount Due" is due and payable in six (6) monthly installments.

Plan B. The entire amount indicated in "Total Amount Due" is due in a single payment.

* Select Payment Plan:

* Yes, I agree and confirm all the information.

Yes, I agree and confirm all the information.

Sun, April 28 2024 20 Nisan 5784

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