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Bat Mitzvah Club

ב"ה

Bat Mitzvah Club Registration Form

Bat Mitzvah Club Attendee
Full Name*
First Name Last Name
Hebrew Name* Ex: Rachel or רחל
Current Grade*
Birthday*

Month Day Year
Birthday Before Sunset?*

YesNoNot sure

Address*

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

Emergency Contact Info
Full Name*
First Name Last Name
Phone Number*
Relationship to Child*
Father
Full Name*
First Name Last Name
E-mail*
Phone Number*
Mother
Full Name*
First Name Last Name
E-mail*
Phone Number*
Are the child's biological parents Jewish by birth?*
Have there been any conversions or adoptions in your family?*
If Yes, please explain*
Payment
Bat Mitzvah Club Membership Payement*

$180
Total

$0.00

Payment*

Credit Card Paypal

Postal / Zip Code

Country

I would like to receive news and updates by email
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