Bat Mitzvah Registration

Bat Mitzvah Club Attendee

First Name *

Last Name *

Hebrew Name

Example: David or דוד

Current Grade

Gender *

Birth Date *

Month

Day

Year

Birth Date Before Sunset

Yes

Street Address

State/Province

City

ZIP/Postal Code

Emergency Contact Info

Full Name

Phone Number

Relationship to Child

Father

First Name *

Last Name *

Email *

Phone Number *

Is Father Jewish from birth?

Mother

First Name *

Last Name *

Email *

Phone Number *

Is Mother Jewish from birth?

Jewish Background

Are the child's biological parents Jewish by birth? *

Have there been any conversions or adoptions in your family? *

If yes, please explain: *

Full Payment $

Current Date

Month

Day

Year

Bat Mitzvah Club