BMC Application

Child's Name:*
First Name Last Name
Child's Hebrew Name:
Child's Birthday*

Month Day Year
Entering Grade:*
Parent 1 Name:*
First Name Last Name
Parent 2 Name:
First Name Last Name
Phone Number*
E-mail*
Was the natural mother of the child born Jewish?*

YesNo
Were there any conversions or adoptions in your family?*

YesNo
If yes, please explain:
Cost of the Bat Mitzvah Club is $250/year.

Please note: Once submitted, your application will be reviewed. Upon approval, you will receive a payment link.
I would like to pay by:

Credit CardE-Transfer

Payment

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Credit Card

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Credit Card CCV:
Please send E-Transfers to: [email protected]

Please include in the notes that payment is for Bat Mitzvah Club

Please note: Please wait to submit payment until you receive confirmation that your application has been reviewed and accepted.
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