Bat Mitzvah Club

JNY 465 Patricia Ave.

Cost: $450 per year (scholarships available)

Please fill in the contact information of the parent filling in the form

Parent of youth program participant

Parent 1 First Name *

Parent 1 Last Name *

Cell Number *

Email *

Event Fee(s)

Scholarship and post dated payments are available

How many children are you registering?

CA$450.00

Total

Please fill in your child's name and date of birth

Child's info

First & last name *

Child's Date of Birth

Please fill in the contact info of parent 2

Parent 2 contact info

Parent 2 First Name

Parent 2 Last Name

Parent 2 cell

How many packages would you like to get?

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