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Programs and Events Bat Mitzvah Club

Bat Mitzvah Club Registration

Yes, we would like to join the Bat Mitzvah Club
1. Student information
Full Name*
First Name Last Name
Hebrew Name
Birth Date

Month Day Year
Phone Number
E-mail
Gender*

Female
What school do you attend?
Grade?
Do you have any previous Jewish education?

YesNoSomewhat
Do you speak/understand/read Hebrew?

YesNoSomewhat

Address

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

Additional notable Information
2. Parents Information:
Parent 1 Full Name
First Name Last Name
Phone Number

Address (if different than above)

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

E-mail
Parent 2 Full Name
First Name Last Name
Phone Number
E-mail

Address (If different than above)

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

Marital Status

MarriedDivorcedSeparated
Mother Born Jewish?

YesNoConverted
Converted By Whom?
3. Emergency Information
Full Name
First Name Last Name
E-mail
Phone Number
Relationship
Does student have any allergies?*

YesNoOption 3
If yes please explain
4. TUITION AND FEES
Tuition: $200 (includes registration and material fees)
- Synagogue membership is NOT required.
- Please note that no child will be turned away due to lack of funds.
Total

$0.00

Payment

Credit Card Paypal Check to Chabad of Snohomish County

Postal / Zip Code

Country

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