Bar and Bat Mitzvah Preparation Classes Registration Form Classes Info: Bar Mitzvah Sessions STARTING JANUARY 18 From 10:00 AM to 12:30 PM Bat Mitzvah Sessions STARTING JANUARY 25 From 10:00 AM to 12:30 PM Cost: $525.00 General Info Full Name: Hebrew Name Age Date of Birth School Attending Grade Attending Mailing Address Address: City, State, Zip: Home Phone: Mother Mother's Name Mother's Hebrew Name Mother's Cell Mother's Email Father Father's Name Father's Hebrew Name Father's Cell Father's Email Synagogue affiliation: Does your child have any difficulties with general studies? Yes No Were there any conversions or adoptions in your family? Yes No If yes, please explain: Emergency Contact #1 Full Name Cell Phone Relationship Emergency Contact #2 Full Name Cell Phone Relationship My Payment info Amount: Please charge my: Credit Card Number Exp. Date: January February March April May June July August September October November December 2015 2016 2017 2018 2019 2020 Comments: This page uses 128 bit SSL encryption to keep your data secure.
