Bat Mitzvah Club Online Registration - ChabadWestHempstead.org

ABOUT SCHEDULE PHOTOS REGISTER
BAT MITZVAH CLUB 2023/2024 5784 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
Click to verify Full Payment of $220.

$220
Check if you would like to sponsor another child for this club.Check if you are in need of a scholarship.
Total

$0.00

Payment

Credit Card Check

Postal / Zip Code

Country

Signature *
For any questions or concerns please contact Chaya Rochel at [email protected] or text (516)-592-2384.
Should be Empty:

This page uses TLS encryption to keep your data secure.

BAT MITZVAH CLUB 2023/2024 5784 REGISTRATION