Bar Mitzvah Club Online Registration - ChabadWestHempstead.org

ABOUT SCHEDULE PHOTOS REGISTER
BAR MITZVAH CLUB 2023 REGISTRATION
SON'S INFORMATION
Son's Name*

First Name Last Name
Birthday*

Month Day Year
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 $180. Please choose one of the following payment options:
Payment Options*

Full payment now of $220Pay by Check
Click to verify Full Payment of $180.

$220

Payment

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

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.
Signature *
For any questions or concerns please contact the Desk at [email protected] or Chaya Rochel at [email protected] or (516)-592-2384.
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BAR MITZVAH CLUB 2023 REGISTRATION