BMC Registration form

Child's Information

Name

Hebrew Name

Address

Phone

Email

School

Grade

Age

Birthday

Time of Birth

Parent's Information

Parent's Name

Relationship

Home phone

Work Phone

Cell Phone

Email

Parent's Information

Parent's Name

Relationship

Home Phone

Work Phone

Cell Phone

Email

Emergency Information

Please list any medical condition or allergy information we should be aware of

Child's Preferences

What are some things you hope to gain from the BMC?

Which of these activities do you enjoy most (Write 1 for the most and 10 for the least)?

Select 1 2 3 4 5 6 7 8 9 10 Writing

Select 1 2 3 4 5 6 7 8 9 10 Public speaking

Select 1 2 3 4 5 6 7 8 9 10 Acting

Select 1 2 3 4 5 6 7 8 9 10 Group leading

Select 1 2 3 4 5 6 7 8 9 10 Singing / Playing a musical instrument

Select 1 2 3 4 5 6 7 8 9 10 Dancing

Select 1 2 3 4 5 6 7 8 9 10 Sports

Select 1 2 3 4 5 6 7 8 9 10 Drawing/Crafting

Select 1 2 3 4 5 6 7 8 9 10 Cooking/Baking

Select 1 2 3 4 5 6 7 8 9 10 Party planning

Tell us 5 WORDS that pop in your head when you hear the words bat mitzvah (don’t worry – there’s no wrong answers!).

Fee Schedule

$180 (Includes all sessions, supplies & refreshments)
$360 - Sponsor (Includes all sessions, supplies & refreshments)

Payment Type:
Please charge my credit card $30 monthly (6 months - Jan-Jun)
Please charge my credit card once for the whole amount

Payment Information:

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