Bat Mitzvah Club Online Registration - ChabadWestHempstead.org

ABOUT SCHEDULE PHOTOS REGISTER
BAT MITZVAH CLUB 2022/2023 5783 REGISTRATION
DAUGHTER'S INFORMATION
Daughter's Name*

First Name Last Name
Daughter's Birthday*

Month Day Year
Daughter's Age*
School*
Grade
Please list any allergies.
PARENT INFORMATION
Parent's Name (1)*

First Name Last Name
Parent's Home Phone (1)*

Area Code Phone Number
Parent's Cell Phone (1)*

Area Code Phone Number
Parent's Email Address (1)*
Parent's Name (2)

First Name Last Name
Parent's Cell Phone (2)

Area Code Phone Number
Comments/Questions
The cost to enroll in this program is $200. Please choose one of the following payment options:
Payment Options*

Full payment now of $200 Pay by Check
Click to verify Full Payment of $200.

$200

Payment

Credit Card

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Check if you would like to sponsor another child for this club. Check if you are in need of a scholarship.
Signature*
For any questions or concerns please contact Chaya Rochel at [email protected] or text (516)-592-2384.
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BAT MITZVAH CLUB 2022/2023 5783 REGISTRATION