Bar Mitzvah Club 2024/2025 Registration Form

Parent Information

Mother`s Name*

First Name Last Name

Mother's Hebrew Name:* *If you are unsure, write NA

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 BirthConvert (before child was born)Not JewishConvert (after child was born

Is Maternal Grandmother? *

Jewish by BirthConvertedNot Jewish

Father`s name:*

First Name Last Name

Father's Hebrew Name:* *If you are unsure, write NA

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

Bar Mitzvah Boy's Information

Full Name:*

First Name Last Name

Hebrew Name:*

Birth Date:*

Month Day Year

Time (Approx)*

Hour Minutes

Anticipated Bar Mitzvah Date:

Month Day Year

at Hour Minutes

Phone Number:

Area Code Phone Number

School:

Grade:*

Jewish Education Level:* BAM provides preparation for all levels.

My son can almost be a rabbiNeeds some brushing upGround Zero

Who Will Be Officiating The Ceremony?*

Rabbi Adi - Chabad at MonterraRabbi Pinny - Chabad of SWB

Emergency Contact and Medical Information

Contact 1:* *Other than parents*

First Name Last Name

Phone Number:*

Area Code Phone Number

Relationship:*

Contact 2:* *Other than parents*

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

Does your child carry an Epi-Pen?*

YesNo

Any medical info BAM leader should know about?*

YesNo

If yes, please specify

Payment Options

2024/2025 Bar Mitzvah Club Tuition:

$100 - Non Refundable Registration Fee

$1,850 - Tuition for paid Members from Chabad at Monterra or Chabad of SWB.

$2,000 - Tuition for Non-Members from Chabad at Monterra or Chabad of SWB.

Are You A Paid Member of Chabad At Monterra or Chabad of SWB?*

I am a paid member at Chabad at MonterraI am a paid member at Chabad of SWBI am not a member

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

1 payment of $1,8502 Payments of $9253 Payments of $616.674 Payments of $462.50

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

1 payment of $2,0002 Payments of $1,0003 Payments of $666.674 Payments of $500

$100 Registration Fee*

Please charge the $100 non refundable registration fee

TUITION POLICY:

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

Payment*

Credit Card Paypal Zelle

Postal / Zip Code

Country

Signature*

I agree to all the fees and policies provided in this BAM 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.

Bar Mitzvah Club 2024/2025 Registration Form

Bar Mitzvah Club Registration Form

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