Bar/Bat Mitzva Registration

Bar/Bat Mitzva Discovery Course Form
Course Selection* Select Program
Student Information
Please complete a separate form for each child you are registering.
Child's Name*

First Name Last Name
Male/Female*

Male Female
Birth Date*

Month Day Year
Hebrew Name
Grade*
School Attending
Hebrew Reading*
Previous Jewish Ed. Describe Jewish Education to date
Educational Learning Style Is there anything that you can share with us about your child that will help us provide for his/her educational needs
Family Information
Mother's Name*

First Name Last Name
Mother' s Hebrew Name

Home Address* If parents live separately, please use this field for Mother's Address. Complete Father's address below

Mother's Email*
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Home Phone

Area Code Phone Number
Mother's Cell*

Area Code Phone Number
Mother's Work

Area Code Phone Number
Father's Name*
Father's E-mail*
Father's Cell

Area Code Phone Number
Father's Work

Area Code Phone Number

Address - If Different than Mother's

Payment*

Credit Card Paypal Check

Postal / Zip Code

Country

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Bar/Bat Mitzva Discovery Course Form