Bat M. Registration

Bat Mitzvah Registration
Parent Name*

First Name Last Name

Address*

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Child's Full Name*

First Name Last Name
Child's E-mail*
Child's Cell Phone*

Area Code Phone Number
Hebrew Name*

First Name Second Name
Birth Date*

Month Day Year
Child* Please Choose One
Child's Biological Mother* Please Choose One
Child's Maternal Biological Grandmother* Please Choose One
Child's Father* Please Choose One
Mother*

First Name Last Name
Mother's Cell Phone*
Mother's E-mail*
Father*

First Name Last Name
Father's Cell Phone*
Father's E-mail*
Desired Service Month* First Choice

Month Day Year
Desired Service Month* Second Choice

Month Day Year
Estimated # of Guests in Attendance at Service*
Please note if child has any learning disabilities or difficulties*
Consent*

I understand that it is my responsibility to oversee my child’s progress, ensure that they thoroughly review the material learned 5 days each week, and to personally study with them if necessary in order to successfully meet the goals of Bat Mitzvah preparation.I agree to make payment of $1,800 to Chabad of NWBC for weekly 30 minute Bat Mitzvah lessons according to the annual schedule of Bat Mitzvah lessons.I agree to a make a minimum donation of $1,040 to Chabad of NWBC for the Bat Mitzvah. This includes meetings with parents, rehearsal, use of facility for service if applicable and conducting of the service by Rabbi or Mimi Kaplan as arranged.I understand that if desired, Coffee, cake and fruit may be served for a charge of $8 per person and $250 for set-up and linen.
Payment*

I will pay $2,840 at this time with the credit card below.I agree to pay $2,840 divided in four payments starting now and concluding one month prior to the Bat Mitzvah service, to be charged to the credit card below.
Notes to Payment Terms

Payment*

Credit Card

We accept Visa, MasterCard, American Express, Discover
Credit Card Number	Security Code
Name on Card
Expiration Month	Expiration Year

Billing Address

Street Address

City

State / Province

Postal / Zip Code

Country

Should be Empty:

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