Bat Mitzvah Club Open house registration form

Parent Information

Mother`s Name*

First NameLast Name

Mother`s Cell*

Area CodePhone Number

Mother`s Email*

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Is Mother Jewish?*

Jewish by BirthConvertedNot Jewish

Is Maternal Grandmother?*

Jewish by BirthConvertedNot Jewish

Father`s name*

First NameLast Name

Father`s Cell*

Area CodePhone Number

Father`s Email*

Address (if different)

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Bat Mitzvah Girl Information

Bat Mitzvah Girl`s full name*

First NameLast Name

Bat Mitzvah Girl`s Hebrew name*

Birth Date*

MonthDayYear

Time (Approx)

HourMinutes

Phone Number

Area CodePhone Number

School

Sibling Information

Sibling 1First & Last Name, Hebrew Name, DOB

Sibling 2First & Last Name, Hebrew Name, DOB

Sibling 3First & Last Name, Hebrew Name, DOB

Emergency Contact and Medical Information

Contact 1

First NameLast Name

Phone Number

Area CodePhone Number

Relationship?

Contact 2

First NameLast Name

Phone Number

Area CodePhone Number

Relationship?

Physician Name

Phone Number

Area CodePhone Number

Address

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Does your child have any allergies?

YesNo

If yes, please specify

Any medical info BMC leader should know about?

YesNo

If yes, please specify

Payment Options

Tuition:
$50 - Non Refundable Deposit
$1800.00* - BMC 2022/2023

- Year end ceremony not inclluded

Please check the payment option of your choice*The office admin will set up payment plans for your convinience

1 payment of $1800Two payments of $9003 Payments of $6004 Payments of $450

$50 Registration Fee*

Please charge the $50 non refundable registration fee

Payment

Credit Card

Credit Card Type
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Signature*

I agree to all the fees and policies provided in this BMC registration form

I would like to receive news and updates by email

Bat Mitzvah Club

Bat Mitzvah Club Open house registration form

Bat Mitzvah Club Registration Form

BMC Cooper City!

Click here to register