Bar Mitzvah Club 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

Bar Mitzvah Boy's Information

Full Name*

First Name Last Name

Hebrew name*

Birth Date*

Month Day Year

Time (Approx)

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 offitiating the ceremony?

Rabbi Adi/- Chabad at MonterraRabbi Pinny - Chabad of SWB

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 BAM leader should know about?

YesNo

If yes, please specify

Payment Options

2023/2024 Bar Mitzvah Club Tuition:

$100 - Non Refundable Deposit

$1650.00* - Tuition for paid Members from Chabad at Monterra or Chabad of SWB.

$1800.00* - 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.

One payment of $1,6502 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.

One payment of $1,8002 Payments of $9003 Payments of $6004 Payments of $450

$100 Registration Fee*

Please charge the $100 non refundable registration fee

Payment

Credit Card Paypal Zelle or Venmo

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 Registration Form

Bar Mitzvah Club Registration Form

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