Bat Mitzvah Club Registration Form

Address*

Cellular Number
- Area CodePhone Number
Age
Grade
School*
E-mail*
Member's E-mail address that is checked daily
Add to mailing list
English Birth Date*
MonthDayYear
Hour of Birth
Required if you don't know your Hebrew date
Hebrew Birthday
Family Information
Father's Name
Fathers Number*
- Area CodePhone Number
Mother's Name
Mothers Number*
- Area CodePhone Number
Parent's E-mail
Is the natural mother of the child Jewish?*
YesNo
Where there any conversions or adoptions in your family*
YesNo
If yes, please describe
Membership
There is a 180$ membership fee, which includes all club meetings, supplies and refreshments. You can make a check made out to CHABAD