Bas Mitzvah Course

 

Bar/s Mitzvah 6 week club is $75.
Registration closes ____.
FIRST CLASS ___.

 

REGISTRATION FORM
General Information
Where did you hear about us
Student's Information
Child's First Name *
Last Name *  
Birth Date (MM/DD/YYYY) *  
Approximate time of day when born and location of birth
Child's Current Grade  *  
Parents Information
Father's First Name *
Mother's First Name *
Address *
City *
State *
ZIP *
Country *
Home Phone *
Father Cell *
Mother Cell *
Father's Email  *
Mother's Email  *
Additional Information
Which school is your child currently attending? *
What are you hoping your child will gain in this class? * 
Please choose which course you are registering for *
* = Required Fields