Bat Mitzvah Registration Form

Parent Information

Mother`s Name*

First Name Last Name

Mother`s Cell*

Area Code Phone 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 Name Last Name

Father`s Cell *

Area Code Phone 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 Name Last Name

Bat Mitzvah Girl`s Hebrew name*

Birth Date*

Month Day Year

Time (Approx)

Hour Minutes

Phone Number

Area Code Phone Number

School

Sibling Information

Sibling 1 First & Last Name, Hebrew Name, DOB

Sibling 2 First & Last Name, Hebrew Name, DOB

Sibling 3 First & Last Name, Hebrew Name, DOB

Emergency Contact and Medical Information

Contact 1

First Name Last Name

Phone Number

Area Code Phone Number

Relationship?

Contact 2

First Name Last Name

Phone Number

Area Code Phone Number

Relationship?

Physician Name

Phone Number

Area Code Phone 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

2023/2024 Bat Mitzvah Club Tuition:

$50* - Non Refundable Deposit

$1,650.00* - Tuition for paid Members from Chabad at Monterra or Chabad of SWB.

$1,800.00* - Tuition for Non Members from Chabad at Monterra or Chabad of SWB.

- Year end ceremony not included

Members, please check the payment option of your choice: The office Admin will set up payment plans for your convenience.

1 payment of $16502 payments of $8253 Payments of $5504 Payments of $412.50

Non-Members, please check the payment option of your choice: The office Admin will set up payment plans for your convenience.

1 payment of $18002 payments of $9003 Payments of $6004 Payments of $450

$50 Registration Fee*

Please charge the $50 non refundable registration fee

POLICY:

THERE ARE NO PRO-RATING OPTIONS REGARDLESS OF WHEN YOU JOIN!

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Signature*

I agree to all the fees and policies provided in this BMC registration form.I agree that all fees/payments are non refundable at the time of payment.

I would like to receive news and updates from Chabad at Monterra by email. I understand that information I provide to Chabad at Monterra will be used according to its Privacy Policy and I can unsubscribe at any time.

Bat Mitzvah Club Registration Form

Membership

The Shul

High Holidays

Sponsorships and Dedications

Life Cycle Events

Community Events & Programs