Registration

Bat Mitzvah Club
Registration Form
Every Sunday from 10:00 AM to 12:30 PM
at the Silverstein Hebrew Academy, 117 Cutter Mill Road, Great Neck NY
Girls Name*
First NameLast Name
Birth Date*
MonthDayYear
Basic Info*
AgeHebrew NameSchool AttendingGrade Entering

Address*

Mother's Info

Father's Info

Emergency Contact #1*

Emergency Contact #2*

To enhance our curriculum we have school events and programs.
Would you be willing to assist in even planning?
YesNo
Would you like to be a class mother?
YesNo
I hereby permit my child to participate in all activities, join in class and school trips on and beyond school properties. In case of an emergency, I herby authorize the school to have my child taken care of by a physician in any way that the situation may call for.
Signature of Parent/Guardian: (Please enter your email address)*
Today's Date*
MonthDayYear
Cost is $500
Amount to charge
$
Total
$0.00

Payment*

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

This page uses TLS encryption to keep your data secure.

Bat Mitzvah Club