Bar Mitzvah Club Club13 2024

Child Name*

First NameLast Name
Hebrew Name
If known
School - September 2024 - 2025*
Grade - September 2024 - 2025*
Birth Date*

MonthDayYear
Date
MorningEvening
YesNo
YesNo
Please Specify*
Who was the Rabbi?*
Does your child have any allergies? What should be done in the case of an allergic reaction?
Parent Information
Mother Name*
Mother Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
Father Cell Number*
Please enter a valid phone number.Format: (000) 000-0000.
Father Name*

First NameLast Name
Parent Email *
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Payment Information: $180 for the year

Please note: No one will be turned away due to lack of funds. Please submit this form and contact Hadassah for financial assistance or a payment plan: 516-458-3694

Bar Mitzvah Club Payment

Bar Mitzvah Club - Hebrew School

$180.00

Enter coupon

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Thank you for registerting for our Bar Mitzvah program! Your child will thank you!

Hadassah will be in touch with you with more information - if you have any questions feel free to reach out: 516-458-3694
Should be Empty:

Parent Information